Provider Demographics
NPI:1003496449
Name:CHIDAMBARAM, VIGNESH (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:VIGNESH
Middle Name:
Last Name:CHIDAMBARAM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CHARLES PLZ APT 803
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4216
Mailing Address - Country:US
Mailing Address - Phone:443-854-9545
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 639
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program