MEDICARE: DR. ANNICK PAYONG CHIMA HEBOU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0092835	MD
2	207R00000X	Internal Medicine Physician	MD036989	DC

General Provider Information

NPI Number	:	1629235759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNICK PAYONG CHIMA HEBOU MD

Provider Business Mailing Address
First Line	:	3500 OLD WASHINGTON RD STE 102
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3205
Country	:	US
Telephone Number	:	240-514-2323
Fax Number	:	240-514-8851

Provider Business Practice Location Address
First Line	:	3500 OLD WASHINGTON RD STE 102
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3205
Country	:	US
Telephone Number	:	240-514-2323
Fax Number	:	240-514-8851

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	07/18/2022

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