Provider Demographics
NPI:1083919047
Name:SHOBHA CHIDAMBARAM, MD, PC
Entity Type:Organization
Organization Name:SHOBHA CHIDAMBARAM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOBHA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CHIDAMBARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-839-1590
Mailing Address - Street 1:6196 OXON HILL RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3100
Mailing Address - Country:US
Mailing Address - Phone:301-839-1590
Mailing Address - Fax:301-839-2690
Practice Address - Street 1:1406 GREENWOOD PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1604
Practice Address - Country:US
Practice Address - Phone:301-839-1590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00297442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty