Provider Demographics
NPI:1245380278
Name:V. PREM CHANDAR, M.D., P.A.
Entity Type:Organization
Organization Name:V. PREM CHANDAR, M.D., P.A.
Other - Org Name:AFFILIATED DIGESTIVE DISEASE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SASIKALA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-773-1111
Mailing Address - Street 1:6001 LANDOVER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1143
Mailing Address - Country:US
Mailing Address - Phone:301-773-1111
Mailing Address - Fax:301-773-7869
Practice Address - Street 1:6001 LANDOVER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1143
Practice Address - Country:US
Practice Address - Phone:301-773-1111
Practice Address - Fax:301-773-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD16380207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD143601500Medicaid
DC100006612OtherMEDICARE RR
DC100006612OtherMEDICARE RR