Healthcare Provider Details

I. General information

NPI: 1447519491
Provider Name (Legal Business Name): NISENFELD & CHILTON, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 THOMAS JOHNSON CT
FREDERICK MD
21702-4348
US

IV. Provider business mailing address

184 THOMAS JOHNSON DR STE. 104
FREDERICK MD
21702-4360
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-8311
  • Fax: 301-694-3537
Mailing address:
  • Phone: 301-694-8311
  • Fax: 301-694-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: QUINTEN DAVIS
Title or Position: COO
Credential:
Phone: 301-694-8311