Provider Demographics
NPI:1275947467
Name:CHAND, MAMATA
Entity Type:Individual
Prefix:
First Name:MAMATA
Middle Name:
Last Name:CHAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 DEFENSE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8922
Mailing Address - Country:US
Mailing Address - Phone:410-897-1941
Mailing Address - Fax:
Practice Address - Street 1:3620 JOSEPH SIEWICK DR STE 306
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1760
Practice Address - Country:US
Practice Address - Phone:410-897-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263007207RR0500X
MDD83484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine