Healthcare Provider Details

I. General information

NPI: 1508965930
Provider Name (Legal Business Name): ANTHONY ALOYSIUS CHICO III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 OSLER DRIVE STE 402
TOWSON MD
21204
US

IV. Provider business mailing address

6535 N CHARLES ST STE 300
BALTO MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-0103
  • Fax: 410-828-0102
Mailing address:
  • Phone: 410-938-5252
  • Fax: 410-938-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH0059634
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: