Healthcare Provider Details

I. General information

NPI: 1063699577
Provider Name (Legal Business Name): DANIEL BRIAN CHACHICH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NORTH GREENE STREET
BALTIMORE MD
21201
US

IV. Provider business mailing address

10 NORTH GREEN STREET DEPARTMENT OF SURGERY
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7237
  • Fax: 410-605-7919
Mailing address:
  • Phone: 410-605-7237
  • Fax: 410-605-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR077916
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: