Provider Demographics
NPI:1710182241
Name:INTERNAL MEDICINE OF LOUDOUN, LLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF LOUDOUN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-858-7007
Mailing Address - Street 1:19455 DEERFIELD AVE
Mailing Address - Street 2:306
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-1754
Mailing Address - Country:US
Mailing Address - Phone:703-858-7007
Mailing Address - Fax:703-858-5007
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:703-858-7007
Practice Address - Fax:703-858-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043219710Medicaid
DN1371OtherMEDICARE RAILROAD
VAC10449Medicare PIN