Healthcare Provider Details

I. General information

NPI: 1639599772
Provider Name (Legal Business Name): COLLEEN WICHSER MEEHAN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 MEDICAL CENTER DR
ROCKVILLE MD
20850-3357
US

IV. Provider business mailing address

900 JANNEYS LN
ALEXANDRIA VA
22302-3920
US

V. Phone/Fax

Practice location:
  • Phone: 240-826-6000
  • Fax:
Mailing address:
  • Phone: 770-375-0276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0082976
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: