Basic Information
| Provider Information | |||||||||
| NPI: | 1104026129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAWLA | ||||||||
| FirstName: | KIRANPREET | ||||||||
| MiddleName: | KAUR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 W PRATT ST | ||||||||
| Address2: | SUITE 880 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212012423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103285964 | ||||||||
| FaxNumber: | 4103283379 | ||||||||
| Practice Location | |||||||||
| Address1: | 419 W REDWOOD ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6672141300 | ||||||||
| FaxNumber: | 4103282648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 05/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | 246568 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D74186 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 447712000 | 05 | MD | MEDICAID |