Provider Demographics
NPI:1073317590
Name:CHANDRA, DIVYA K
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:K
Last Name:CHANDRA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6837 CREEKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1705
Mailing Address - Country:US
Mailing Address - Phone:410-852-6930
Mailing Address - Fax:
Practice Address - Street 1:600 GRESHAM DRIVE
Practice Address - Street 2:RALEIGH BUILDING, SUITE 304
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-388-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program