Provider Demographics
NPI:1235908245
Name:EDEN PHARMACOLOGY CENTER
Entity Type:Organization
Organization Name:EDEN PHARMACOLOGY CENTER
Other - Org Name:EDEN PHARMACOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/STAFF PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JIHO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-298-9890
Mailing Address - Street 1:481 N FREDERICK AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2470
Mailing Address - Country:US
Mailing Address - Phone:301-338-8119
Mailing Address - Fax:301-869-9909
Practice Address - Street 1:481 N FREDERICK AVE STE 103
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2470
Practice Address - Country:US
Practice Address - Phone:301-298-9890
Practice Address - Fax:301-869-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty