Healthcare Provider Details

I. General information

NPI: 1992084073
Provider Name (Legal Business Name): THE FDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ROCKVILLE PIKE RM 216S
ROCKVILLE MD
20852-1450
US

IV. Provider business mailing address

14036 NATIA MANOR DR
NORTH POTOMAC MD
20878-4857
US

V. Phone/Fax

Practice location:
  • Phone: 301-827-5102
  • Fax:
Mailing address:
  • Phone: 301-919-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberD0060264
License Number StateMD

VIII. Authorized Official

Name: DR. CHANGTING CHEN HAUDENSCHILD
Title or Position: MEDICAL OFFICER
Credential: M.D.
Phone: 301-827-5102