Provider Demographics
NPI:1871774232
Name:DAHAGAM, CHAITANYA KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:KRISHNA
Last Name:DAHAGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8819 BLUE ROYALE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2150
Mailing Address - Country:US
Mailing Address - Phone:256-457-7701
Mailing Address - Fax:
Practice Address - Street 1:8819 BLUE ROYALE LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2150
Practice Address - Country:US
Practice Address - Phone:256-457-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251530208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery