Provider Demographics
NPI:1558543017
Name:CHANDRA, POORNIMA (MD)
Entity Type:Individual
Prefix:MS
First Name:POORNIMA
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 1:8988 FERN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1635
Mailing Address - Country:US
Mailing Address - Phone:703-978-6061
Mailing Address - Fax:703-978-0291
Practice Address - Street 1:8988 FERN PARK DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1635
Practice Address - Country:US
Practice Address - Phone:703-978-6061
Practice Address - Fax:703-978-0291
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240590208000000X
DCMD036620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics