Healthcare Provider Details

I. General information

NPI: 1154181568
Provider Name (Legal Business Name): BETHESDA-CHEVY CHASE ORTHOPAEDIC A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3835 PLYERS MILL RD
KENSINGTON MD
20895-2015
US

IV. Provider business mailing address

10215 FERNWOOD RD STE 506
BETHESDA MD
20817-1184
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-1010
  • Fax:
Mailing address:
  • Phone: 301-530-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHUCK GRASMEDER
Title or Position: REGIONAL DIRECTOR OF OPERATIONS
Credential:
Phone: 240-482-2412