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General NPI Number Information
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NPI Number | 1932457587
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Entity Type | Organization
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Legal Business Name | CHEVERLY PEDIATRICS
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 6490 LANDOVER RD STE G
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City | CHEVERLY
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State | MD
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Zip | 20785-1443
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Country | US
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Telephone | 301-322-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 6490 LANDOVER RD STE G
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City | CHEVERLY
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State | MD
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Zip | 20785-1443
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Country | US
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Telephone | 301-322-1117
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MAISLYN ANNMARIE CHRISTIE
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Credential |
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Telephone | 301-322-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D38739
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License Number State | MD
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