Provider Demographics
NPI:1316989312
Name:CHAWLA, INDER (MD)
Entity type:Individual
Prefix:DR
First Name:INDER
Middle Name:
Last Name:CHAWLA
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:PO BOX 59236
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-9236
Mailing Address - Country:US
Mailing Address - Phone:301-469-6242
Mailing Address - Fax:301-983-6286
Practice Address - Street 1:7600 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6367
Practice Address - Country:US
Practice Address - Phone:301-891-5393
Practice Address - Fax:301-891-6184
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
23118OtherMAMSI/MDIPA/OPTIMUM CHOIC
DC0001OtherBCBS
DC010624100Medicaid
MD786001300Medicaid
MD41189401OtherBCBS
4608OtherAETNA
MD409433OtherMEDICARE PTAN
MD786001300Medicaid