Provider Demographics
NPI:1467966739
Name:CHOH, CLOTILDA (NP)
Entity Type:Individual
Prefix:
First Name:CLOTILDA
Middle Name:
Last Name:CHOH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15503 SYMONDSBURY WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8045
Mailing Address - Country:US
Mailing Address - Phone:240-425-2388
Mailing Address - Fax:877-543-9437
Practice Address - Street 1:4740 PEARSON DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5413
Practice Address - Country:US
Practice Address - Phone:240-425-2388
Practice Address - Fax:877-543-9437
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-25
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
MDR205638363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
47-3317137OtherN/A