Provider Demographics
NPI:1376655035
Name:CHANDRA, RENU (MD)
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 PISCATAWAY RD
Mailing Address - Street 2:#710
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:#710
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2508
Practice Address - Country:US
Practice Address - Phone:301-868-8654
Practice Address - Fax:301-856-7298
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics