Healthcare Provider Details

I. General information

NPI: 1669423760
Provider Name (Legal Business Name): BETTY CHOU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

PO BOX 64313
BALTIMORE MD
21264-4313
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-4605
  • Fax:
Mailing address:
  • Phone: 410-550-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD60369
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: