Provider Demographics
NPI:1982797718
Name:CHANDRA, MAHESH (MD)
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:
Last Name:CHANDRA
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 1:9131 PISCATAWAY RD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735
Mailing Address - Country:US
Mailing Address - Phone:301-868-8654
Mailing Address - Fax:301-856-7298
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:SUITE 710
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735
Practice Address - Country:US
Practice Address - Phone:301-868-8654
Practice Address - Fax:301-856-7298
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027902207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3200041OtherUNITED HEALTHCARE INS
DC00017637OtherCAREFIRST BCBS
400075OtherTRICARE
7398022OtherOPTIMUM CHOICE
010004037OtherUNITED HEALTHCARE INS
146019400OtherACS-DOL
MD2343OtherCAREFIRST BCBS
MD319251201Medicaid