Provider Demographics
NPI:1902963309
Name:CHEVY CHASE PEDIATRIC CENTER P.C.
Entity Type:Organization
Organization Name:CHEVY CHASE PEDIATRIC CENTER P.C.
Other - Org Name:CHEVY CHASE PEDIATRIC CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-363-0300
Mailing Address - Street 1:6931 ARLINGTON RD STE 340
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5231
Mailing Address - Country:US
Mailing Address - Phone:202-363-0300
Mailing Address - Fax:202-363-7251
Practice Address - Street 1:6931 ARLINGTON RD STE 340
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5231
Practice Address - Country:US
Practice Address - Phone:202-363-0300
Practice Address - Fax:202-363-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
DCMD12072261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC=========OtherTAX EIN