1497801039 NPI number — CHEVY CHASE ENT ASSOCIATES, LLC

Table of content: (NPI 1497801039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497801039 NPI number — CHEVY CHASE ENT ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEVY CHASE ENT ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497801039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5530 WISCONSIN AVE
Provider Second Line Business Mailing Address:
SUITE #1455
Provider Business Mailing Address City Name:
CHEVY CHASE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20815-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-656-8630
Provider Business Mailing Address Fax Number:
301-656-8631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5530 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
SUITE #1455
Provider Business Practice Location Address City Name:
CHEVY CHASE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20815-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-656-8630
Provider Business Practice Location Address Fax Number:
301-656-8631
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WINKLER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-656-8630

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207YP0228X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0W54TP . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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