Provider Demographics
NPI:1417642919
Name:CHONJU, GERARD
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:CHONJU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11526 SEQUOIA LN
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1467
Mailing Address - Country:US
Mailing Address - Phone:240-906-0022
Mailing Address - Fax:
Practice Address - Street 1:11202 MARWOOD HILL DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1241
Practice Address - Country:US
Practice Address - Phone:770-331-7912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator