| Lakeside Medical Group-dr. Raj Chawla P.c. | |
|
14300 Gallant Fox Ln Ste 210 Bowie MD 20715-4033 | |
| (301) 809-5556 | |
| (301) 809-5510 |
| Full Name | Lakeside Medical Group-dr. Raj Chawla P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 14300 Gallant Fox Ln Ste 210, Bowie, Maryland |
| Authorized Official Name and Position | Raj Chawla (PRESIDENT) |
| Authorized Official Contact | 3018096494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Medical Group-dr. Raj Chawla P.c. 14300 Gallant Fox Ln Ste 205 Bowie MD 20715-4033 Ph: (301) 809-6494 | Lakeside Medical Group-dr. Raj Chawla P.c. 14300 Gallant Fox Ln Ste 210 Bowie MD 20715-4033 Ph: (301) 809-5556 |
| NPI Number | 1558423822 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 4284675703 |
|---|---|
| Medicare Enrollment ID | O20050516000277 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558423822 | NPI | - | NPPES |
| 407439400 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Maryland) | Primary |
| Provider Name | Raj K Chawla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750357026 PECOS PAC ID: 2860432333 Enrollment ID: I20050504001007 |
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