Provider Demographics
NPI:1326334244
Name:CHANTILLY REHAB PHYSICIANS PC
Entity Type:Organization
Organization Name:CHANTILLY REHAB PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-991-9778
Mailing Address - Street 1:PO BOX 2207
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-0207
Mailing Address - Country:US
Mailing Address - Phone:703-991-9778
Mailing Address - Fax:
Practice Address - Street 1:24430 MILLSTREAM DR
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3098
Practice Address - Country:US
Practice Address - Phone:703-991-9778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238655208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1437118437Medicaid
VAA149Medicare PIN