Provider Demographics
NPI:1275769168
Name:CHENTHITTA, ANIL MATHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:MATHEW
Last Name:CHENTHITTA
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 1:19450 DEERFIELD AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6821
Mailing Address - Country:US
Mailing Address - Phone:571-510-3815
Mailing Address - Fax:571-510-3675
Practice Address - Street 1:19450 DEERFIELD AVE STE 280
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6821
Practice Address - Country:US
Practice Address - Phone:571-510-3815
Practice Address - Fax:571-510-3675
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128763208VP0014X
VA01012529292081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101252929OtherLICENSE NO
VA1275769168Medicaid
VAP01159671OtherRR MEDICARE
FLIR369ZMedicare PIN
FLIR369XMedicare PIN
VAP01159671OtherRR MEDICARE
VA0101252929OtherLICENSE NO