Healthcare Provider Details

I. General information

NPI: 1730644733
Provider Name (Legal Business Name): CHIMATARA ROSE CHIKWERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST
TOWSON MD
21204-6881
US

IV. Provider business mailing address

7604 CHESTERFIELD WAY
BALTIMORE MD
21237-3370
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2000
  • Fax:
Mailing address:
  • Phone: 443-929-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180775
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR155156
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: