Healthcare Provider Details

I. General information

NPI: 1740364942
Provider Name (Legal Business Name): MARIAM M CHASE MSN. RN. CS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8818 GEORGIA AVE SUITE 501, FIRST FLOOR
SILVER SPRING MD
20910-2713
US

IV. Provider business mailing address

8226 SKIPWITH DR
FREDERICK MD
21702-9499
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-3353
  • Fax: 240-777-1367
Mailing address:
  • Phone: 301-631-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR081733
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: