Healthcare Provider Details

I. General information

NPI: 1932457587
Provider Name (Legal Business Name): CHEVERLY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 LANDOVER RD STE G
CHEVERLY MD
20785-1443
US

IV. Provider business mailing address

6490 LANDOVER RD STE G
CHEVERLY MD
20785-1443
US

V. Phone/Fax

Practice location:
  • Phone: 301-322-1117
  • Fax:
Mailing address:
  • Phone: 301-322-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD38739
License Number StateMD

VIII. Authorized Official

Name: DR. MAISLYN ANNMARIE CHRISTIE
Title or Position: PHYSICIAN
Credential:
Phone: 301-322-1117