Individual
DR. CHAITANYA SURENDRA MANGALMURTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12255 FAIR LAKES PKWY, KAISER PERMANENTE FAIR OAKS MEDICAL CENTER, FAIRFAX, VA 22033-3952
(703) 934-5700
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101221322
VA
208600000X
Surgery Physician
D0066199
MD
208600000X
Surgery Physician
J4324
TX
208600000X
Surgery Physician
MD31721
DC
Other
Enumeration date
10/03/2006
Last updated
12/03/2021
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