Healthcare Provider Details

I. General information

NPI: 1871787077
Provider Name (Legal Business Name): BETHESDA PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 WOODMONT AVE SUITE 320
BETHESDA MD
20814-2743
US

IV. Provider business mailing address

8120 WOODMONT AVE SUITE 320
BETHESDA MD
20814-2743
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-4010
  • Fax: 301-654-2319
Mailing address:
  • Phone: 301-656-4010
  • Fax: 301-654-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberD45225
License Number StateMD

VIII. Authorized Official

Name: DR. JANE H CHRETIEN
Title or Position: CO-OWNER/SECRETARY OF CORPORATION
Credential: M.D.
Phone: 301-656-4010