Provider Demographics
NPI:1013642123
Name:CHEPHETS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:CHEPHETS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:WIREDU
Authorized Official - Last Name:AIDOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-441-5190
Mailing Address - Street 1:8204 MAPLE CLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-5558
Mailing Address - Country:US
Mailing Address - Phone:202-441-5190
Mailing Address - Fax:
Practice Address - Street 1:2415 MUSGROVE RD STE 308
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5223
Practice Address - Country:US
Practice Address - Phone:202-441-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center