MEDICARE: CHASE BREXTON

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1912515008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHASE BREXTON

Provider Business Mailing Address
First Line	:	8604 BRIARWOOD CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-1320
Country	:	US
Telephone Number	:	301-256-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 SECURITY BLVD STE 200
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21244-2412
Country	:	US
Telephone Number	:	410-837-2050
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	VIVIANE FLORA DICOUM
Credential	:
Telephone Number	:	301-256-7200

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	04/24/2026

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Directions to “CHASE BREXTON ” Practice Location

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