Provider Demographics
NPI:1790759348
Name:DADLANI, CHICKY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHICKY
Middle Name:
Last Name:DADLANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 BEVERLY ROAD SECOND FLOOR
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3603
Mailing Address - Country:US
Mailing Address - Phone:703-790-5850
Mailing Address - Fax:703-790-1028
Practice Address - Street 1:1365 BEVERLY RD SECOND FLOOR
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3603
Practice Address - Country:US
Practice Address - Phone:703-790-5850
Practice Address - Fax:703-790-1028
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01001244894207N00000X
VA0101244894207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790759348OtherMEDICARE PTAN
VA1790759348OtherMEDICARE PTAN