Provider Demographics
NPI:1265467211
Name:CHANDER, MAHESH (MD)
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:
Last Name:CHANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2807
Mailing Address - Country:US
Mailing Address - Phone:540-636-6131
Mailing Address - Fax:540-636-8774
Practice Address - Street 1:315 W 10TH ST
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2807
Practice Address - Country:US
Practice Address - Phone:540-636-6131
Practice Address - Fax:540-636-8774
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1265467211OtherNPI
VA1265467211Medicaid
VAB81965Medicare UPIN
VAC00802Medicare Oscar/Certification