Provider Demographics
NPI:1790169308
Name:CHAWLA, MANISHA K
Entity Type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:K
Last Name:CHAWLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S EADS ST
Mailing Address - Street 2:APT 819
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3027
Mailing Address - Country:US
Mailing Address - Phone:202-207-6677
Mailing Address - Fax:
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3240
Practice Address - Country:US
Practice Address - Phone:301-638-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15989122300000X
VA0401414906122300000X
DCDEN1001517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist