Provider Demographics
NPI:1386834679
Name:JOSUE, CHOLET KELLY (MD)
Entity Type:Individual
Prefix:
First Name:CHOLET
Middle Name:KELLY
Last Name:JOSUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:8228 HARVEST BEND LN APT 14
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6150
Mailing Address - Country:US
Mailing Address - Phone:312-491-0183
Mailing Address - Fax:410-825-2890
Practice Address - Street 1:14201 LAUREL PARK DR STE 221
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:312-491-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00679562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry