MEDICARE: CHEVY CHASE PEDIATRIC CENTER P.C.

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	261QM2500X	Medical Specialty Clinic/Center	MD12072	DC
2	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1902963309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEVY CHASE PEDIATRIC CENTER P.C.

Provider Business Mailing Address
First Line	:	6931 ARLINGTON RD STE 340
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-5231
Country	:	US
Telephone Number	:	202-363-0300
Fax Number	:	202-363-7251

Provider Business Practice Location Address
First Line	:	6931 ARLINGTON RD STE 340
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-5231
Country	:	US
Telephone Number	:	202-363-0300
Fax Number	:	202-363-7251

Authorized Official
Title or Position	:	OWNER
Name	:	HOWARD BENNETT
Credential	:	MD
Telephone Number	:	202-363-0300

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/15/2023

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