Healthcare Provider Details

I. General information

NPI: 1053817130
Provider Name (Legal Business Name): CHRISTOPHER ROBERT CHANOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 MEDICAL CENTER DR
ROCKVILLE MD
20850-3357
US

IV. Provider business mailing address

8316 TRAFORD LN STE 1
SPRINGFIELD VA
22152-1662
US

V. Phone/Fax

Practice location:
  • Phone: 240-826-6000
  • Fax:
Mailing address:
  • Phone: 703-569-8400
  • Fax: 703-569-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101272368
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0095745
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: