Provider Demographics
NPI:1356988786
Name:JAIN, CHARU AGGARWAL
Entity type:Individual
Prefix:
First Name:CHARU
Middle Name:AGGARWAL
Last Name:JAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARU
Other - Middle Name:
Other - Last Name:AGGARWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7556 TEAGUE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1969
Mailing Address - Country:US
Mailing Address - Phone:410-514-6041
Mailing Address - Fax:
Practice Address - Street 1:7556 TEAGUE RD STE 112
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1969
Practice Address - Country:US
Practice Address - Phone:410-514-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily