Provider Demographics
NPI:1598206773
Name:HARSCH, CHANTEL M (DO)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:M
Last Name:HARSCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHANTEL
Other - Middle Name:M
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3125 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-3105
Mailing Address - Country:US
Mailing Address - Phone:516-532-4011
Mailing Address - Fax:
Practice Address - Street 1:2501 PARKERS LN # 3A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3209
Practice Address - Country:US
Practice Address - Phone:703-289-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01160304692084P0800X
VA01022056862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry