Healthcare Provider Details

I. General information

NPI: 1730744905
Provider Name (Legal Business Name): ETHAN HOCHHEISER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 SANGAMORE RD # 210N
BETHESDA MD
20816-2508
US

IV. Provider business mailing address

727 W 40TH ST APT 547
BALTIMORE MD
21211-2354
US

V. Phone/Fax

Practice location:
  • Phone: 301-569-2202
  • Fax: 352-837-5368
Mailing address:
  • Phone:
  • Fax: 352-837-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number310954
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0100702
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: