Healthcare Provider Details

I. General information

NPI: 1235908245
Provider Name (Legal Business Name): EDEN PHARMACOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 N FREDERICK AVE STE 103
GAITHERSBURG MD
20877-2470
US

IV. Provider business mailing address

481 N FREDERICK AVE STE 103
GAITHERSBURG MD
20877-2470
US

V. Phone/Fax

Practice location:
  • Phone: 301-298-9890
  • Fax: 301-869-9909
Mailing address:
  • Phone: 301-338-8119
  • Fax: 301-869-9909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JIHO CHOI
Title or Position: OWNER/STAFF PHYSICIAN
Credential: MD
Phone: 301-298-9890