Provider Demographics
NPI:1700875226
Name:CHAKURKAR, ASHWIN B (MD)
Entity Type:Individual
Prefix:
First Name:ASHWIN
Middle Name:B
Last Name:CHAKURKAR
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 1:14139 POTOMAC MILLS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4644
Mailing Address - Country:US
Mailing Address - Phone:703-490-8400
Mailing Address - Fax:703-490-7635
Practice Address - Street 1:14139 POTOMAC MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4644
Practice Address - Country:US
Practice Address - Phone:703-490-8400
Practice Address - Fax:703-490-7635
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006726411Medicaid
MD370001276Medicare ID - Type Unspecified
H55030Medicare UPIN
VA006726411Medicaid