Healthcare Provider Details

I. General information

NPI: 1558566919
Provider Name (Legal Business Name): EILEEN MOOD CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 ROCKVILLE PIKE STE 404
N BETHESDA MD
20852-3030
US

IV. Provider business mailing address

19735 GERMANTOWN RD STE 200
GERMANTOWN MD
20874-1217
US

V. Phone/Fax

Practice location:
  • Phone: 301-230-2280
  • Fax: 301-230-2245
Mailing address:
  • Phone: 301-230-2280
  • Fax: 301-230-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR171269
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: