Healthcare Provider Details

I. General information

NPI: 1689168627
Provider Name (Legal Business Name): CHEVY CHASE FOOT & ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 07/07/2023
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 UNIVERSITY BLVD E STE 21
SILVER SPRING MD
20903
US

IV. Provider business mailing address

831 UNIVERSITY BLVD E STE 21
SILVER SPRING MD
20903-2920
US

V. Phone/Fax

Practice location:
  • Phone: 240-641-8735
  • Fax: 240-641-8740
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01623
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: NAVID SADOUGHI
Title or Position: OWNER
Credential: MD
Phone: 240-641-8735