MEDICARE: BRIGHT HORIZONS PSYCHIATRY LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1922709146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT HORIZONS PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	6000 EXECUTIVE BLVD STE 101
Second Line	:
City	:	NORTH BETHESDA
State	:	MD
Zip	:	20852-3816
Country	:	US
Telephone Number	:	240-599-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	7360 GUILFORD DR STE 100
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-5128
Country	:	US
Telephone Number	:	240-599-1001
Fax Number	:	240-599-1002

Authorized Official
Title or Position	:	OWNER
Name	:	AMIR ETESAM
Credential	:	MD
Telephone Number	:	240-599-1001

Provider Enumeration Date	:	03/14/2023
Last Update Date	:	06/10/2026

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