Healthcare Provider Details

I. General information

NPI: 1497801039
Provider Name (Legal Business Name): CHEVY CHASE ENT ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 WISCONSIN AVE SUITE #1455
CHEVY CHASE MD
20815-4404
US

IV. Provider business mailing address

5530 WISCONSIN AVE SUITE #1455
CHEVY CHASE MD
20815-4404
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-8630
  • Fax: 301-656-8631
Mailing address:
  • Phone: 301-656-8630
  • Fax: 301-656-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS P WINKLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-656-8630