Provider Demographics
NPI:1295940799
Name:CHHUNCHHA, VIRENDRA V (MD)
Entity type:Individual
Prefix:
First Name:VIRENDRA
Middle Name:V
Last Name:CHHUNCHHA
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 1:6653 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5523
Mailing Address - Country:US
Mailing Address - Phone:410-796-3745
Mailing Address - Fax:
Practice Address - Street 1:6653 HUNTER RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5523
Practice Address - Country:US
Practice Address - Phone:410-796-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034323208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice