Healthcare Provider Details

I. General information

NPI: 1902963309
Provider Name (Legal Business Name): CHEVY CHASE PEDIATRIC CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 ARLINGTON RD STE 340
BETHESDA MD
20814-5231
US

IV. Provider business mailing address

6931 ARLINGTON RD STE 340
BETHESDA MD
20814-5231
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-0300
  • Fax: 202-363-7251
Mailing address:
  • Phone: 202-363-0300
  • Fax: 202-363-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD12072
License Number StateDC

VIII. Authorized Official

Name: HOWARD BENNETT
Title or Position: OWNER
Credential: MD
Phone: 202-363-0300