Healthcare Provider Details

I. General information

NPI: 1376005827
Provider Name (Legal Business Name): BETHESDA CHEVY CHASE ORTHOPAEDIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD STE 303
BETHESDA MD
20817-1183
US

IV. Provider business mailing address

10215 FERNWOOD RD STE 506
BETHESDA MD
20817-1184
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-1010
  • Fax:
Mailing address:
  • Phone: 301-530-1010
  • Fax: 301-897-8597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER CANNOVA
Title or Position: PHYSICIAN
Credential:
Phone: 301-530-1013