Healthcare Provider Details

I. General information

NPI: 1689174344
Provider Name (Legal Business Name): AMY CHENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 TANEY AVE STE 201
FREDERICK MD
21702-5126
US

IV. Provider business mailing address

1475 TANEY AVE STE 201
FREDERICK MD
21702-5126
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-0133
  • Fax: 301-695-8604
Mailing address:
  • Phone: 301-662-0133
  • Fax: 301-695-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0088901
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: