Healthcare Provider Details

I. General information

NPI: 1669045076
Provider Name (Legal Business Name): CHRISTOPHER RYAN ROBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 BROSCHART RD
ROCKVILLE MD
20850-3303
US

IV. Provider business mailing address

15000 BROSCHART RD
ROCKVILLE MD
20850-3303
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-6857
  • Fax:
Mailing address:
  • Phone: 301-251-6857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number06818
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number200001369
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: