Healthcare Provider Details

I. General information

NPI: 1275356867
Provider Name (Legal Business Name): RICHARD JASPER DEEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WATKINS MILL RD
GAITHERSBURG MD
20879-3301
US

IV. Provider business mailing address

655 WATKINS MILL RD
GAITHERSBURG MD
20879-3301
US

V. Phone/Fax

Practice location:
  • Phone: 240-632-4000
  • Fax:
Mailing address:
  • Phone: 240-632-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberR244263
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR244263
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: