Provider Demographics
NPI:1427176635
Name:KANSANGRA, CHETNA NILESH (LD)
Entity type:Individual
Prefix:MRS
First Name:CHETNA
Middle Name:NILESH
Last Name:KANSANGRA
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4116
Mailing Address - Country:US
Mailing Address - Phone:301-802-3922
Mailing Address - Fax:301-498-4444
Practice Address - Street 1:414 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4116
Practice Address - Country:US
Practice Address - Phone:301-802-3922
Practice Address - Fax:301-498-4444
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO1687133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered