Provider Demographics
NPI:1699881003
Name:CHANDRA, PREETI (MD)
Entity type:Individual
Prefix:
First Name:PREETI
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:F
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 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-5720
Mailing Address - Fax:410-328-5685
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5720
Practice Address - Fax:410-328-2718
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72352207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD974670-01OtherCAREFIRST BC/BS
MD440801200Medicaid
MDS062-0434OtherCAREFIRST BC/BS REGIONAL
MDP01025446Medicare PIN
MD974670-01OtherCAREFIRST BC/BS
MDS062-0434OtherCAREFIRST BC/BS REGIONAL