Provider Demographics
NPI:1760483663
Name:CHANDAR, VENKATARAMAN PREM (M D)
Entity Type:Individual
Prefix:DR
First Name:VENKATARAMAN
Middle Name:PREM
Last Name:CHANDAR
Suffix:
Gender:M
Credentials:M D
Other - Prefix:DR
Other - First Name:V
Other - Middle Name:P
Other - Last Name:CHANDAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6001 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1143
Mailing Address - Country:US
Mailing Address - Phone:301-773-1111
Mailing Address - Fax:301-773-7869
Practice Address - Street 1:6001 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1143
Practice Address - Country:US
Practice Address - Phone:301-773-1111
Practice Address - Fax:301-773-7869
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-12-13
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
MDD0016380207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB7010001OtherCAREFIRST BCBS
MD52786601OtherCAREFIRST MD
MD45104OtherMDIPA
DC429310V03Medicare PIN
DCB7010001OtherCAREFIRST BCBS