Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 0101252929 | VA |
NPI | 1275769168 |
---|---|
Provider Name | Dr. Anil Mathew Chenthitta |
First Address | Leesburg, VA 20176-6821 |
Second Address | Leesburg, VA 20176-6821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 24/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101252929 | LICENSE NO (01) | VA |
1275769168 | (05) | VA |
P01159671 | RR MEDICARE (01) | VA |