Basic Information
| Provider Information | |||||||||
| NPI: | 1790786721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANDLER | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | KATHERINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CAMARDA | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | KATHERINE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10710 CHARTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210443128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108848000 | ||||||||
| FaxNumber: | 4107108587 | ||||||||
| Practice Location | |||||||||
| Address1: | 10710 CHARTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210443128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108848000 | ||||||||
| FaxNumber: | 4107108587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2005 | ||||||||
| LastUpdateDate: | 10/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D61568 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD14308 | HI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D0061568 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 64908 | GA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 60309907 | WA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 405172600 | 05 | MD | MEDICAID |