Provider Demographics
NPI:1154571321
Name:FAMILY MEDICAL OFFICES OF DR. CHENCHUGALLA, M.D., PC
Entity type:Organization
Organization Name:FAMILY MEDICAL OFFICES OF DR. CHENCHUGALLA, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOHAR
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHENCHUGALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-445-1452
Mailing Address - Street 1:7411 RIGGS RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4246
Mailing Address - Country:US
Mailing Address - Phone:301-445-1452
Mailing Address - Fax:301-560-0841
Practice Address - Street 1:7411 RIGGS RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-4246
Practice Address - Country:US
Practice Address - Phone:301-445-1452
Practice Address - Fax:301-560-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242881261QP2300X
MDD67876261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508982273Medicaid
WV3810011459Medicaid
MD022479100Medicaid
VA016914T57Medicare PIN