| Organization Name: | CHANTILLY FAMILY PRACTICE |
| NPI Number: | 1053592337 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAJESH N MEHRA (MEDICAL DIRECTOR) |
| Mailing Address: | 4437 Brookfield Corporate Dr Chantilly |
| State: | VA US |
| Postal Code: | 201512122 |
| Phone Number: | 7039687277 |
| Fax Number: | 7039685644 |
| NPI Enumeration Date: | 11/15/2007 |
| NPI Last Update Date: | 11/15/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 0102033582 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |