Healthcare Provider Details

I. General information

NPI: 1831862168
Provider Name (Legal Business Name): CHELSEA NICOLE PAINTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 GEORGIA AVE STE 307
SILVER SPRING MD
20902-5006
US

IV. Provider business mailing address

10313 GEORGIA AVE STE 307
SILVER SPRING MD
20902-5006
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-2222
  • Fax:
Mailing address:
  • Phone: 301-754-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAC003847
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: