Basic Information
Provider Information
NPI: 1942365127
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHHABRA
FirstName: SUSAN
MiddleName: K
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 EAST JEFFERSON STREET
Address2: PPQA MEDICARE COMPLIANCE UNIT 6 WEST
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018166660
FaxNumber: 3018166308
Practice Location
Address1: 8503 ARLINGTON BLVD
Address2: SUITE 200
City: FAIRFAX
State: VA
PostalCode: 220314512
CountryCode: US
TelephoneNumber: 7039703222
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/27/2006
LastUpdateDate: 02/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X0101055261VAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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