Healthcare Provider Details

I. General information

NPI: 1376776104
Provider Name (Legal Business Name): MR. RICHARD CHARLES PEHLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CARVEL CIR
EDGEWATER MD
21037-1005
US

IV. Provider business mailing address

8 CARVEL CIR
EDGEWATER MD
21037-1005
US

V. Phone/Fax

Practice location:
  • Phone: 301-466-1713
  • Fax: 410-266-9740
Mailing address:
  • Phone: 301-466-1713
  • Fax: 410-266-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13199
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: