Provider Demographics
NPI:1629180898
Name:CHADHA, VIJAY KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:KUMAR
Last Name:CHADHA
Suffix:
Gender:M
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:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:1800 TOWN CENTER DR STE 214
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3238
Practice Address - Country:US
Practice Address - Phone:703-478-0325
Practice Address - Fax:703-478-2702
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037696207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA060006569OtherRAILROAD MEDICARE
VA1629180898Medicaid
C61916Medicare UPIN
VA265046ZBTPMedicare PIN
G00882Medicare ID - Type Unspecified