Healthcare Provider Details

I. General information

NPI: 1902138720
Provider Name (Legal Business Name): RICHARD WYATT CHILDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR BLDG 10, CRC ROOM 3E-5330
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

10 CENTER DR BLDG 10, CRC ROOM 3E-5330
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-594-8008
  • Fax: 301-480-2664
Mailing address:
  • Phone: 301-594-8008
  • Fax: 301-480-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberD00048201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: