Provider Demographics
NPI:1336686641
Name:CHAGANG, BERTHE (NP)
Entity Type:Individual
Prefix:
First Name:BERTHE
Middle Name:
Last Name:CHAGANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9712 BELAIR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1112
Mailing Address - Country:US
Mailing Address - Phone:410-513-7577
Mailing Address - Fax:410-497-5613
Practice Address - Street 1:9712 BELAIR RD STE 200-202
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1103
Practice Address - Country:US
Practice Address - Phone:410-513-7577
Practice Address - Fax:410-497-5613
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR227027363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health