Provider Demographics
NPI:1497801039
Name:CHEVY CHASE ENT ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CHEVY CHASE ENT ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-656-8630
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE #1455
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-8630
Mailing Address - Fax:301-656-8631
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE #1455
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-8630
Practice Address - Fax:301-656-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0W54TPOtherBLUE CROSS
0W54TPOtherBLUE CROSS