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General NPI Number Information
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NPI Number | 1235908245
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Entity Type | Organization
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Legal Business Name | EDEN PHARMACOLOGY CENTER
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 481 N FREDERICK AVE STE 103
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2470
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Country | US
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Telephone | 301-298-9890
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Fax | 301-869-9909
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Provider Business Mailing Address
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Address Line | 481 N FREDERICK AVE STE 103
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2470
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Country | US
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Telephone | 301-338-8119
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Fax | 301-869-9909
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Authorized Official
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Title or Position | OWNER/STAFF PHYSICIAN
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Name | JIHO CHOI
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Credential | MD
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Telephone | 301-298-9890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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