Provider Demographics
NPI:1467826024
Name:DARDEN, CHATELE
Entity Type:Individual
Prefix:
First Name:CHATELE
Middle Name:
Last Name:DARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8813 WALTHAM WOODS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8813 WALTHAM WOODS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2450
Practice Address - Country:US
Practice Address - Phone:443-219-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM31784225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist