Provider Demographics
NPI:1588234470
Name:CHISHOLM, JOHN ROLLINSON JR
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROLLINSON
Last Name:CHISHOLM
Suffix:JR
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 1:1428 SHADY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1714
Mailing Address - Country:US
Mailing Address - Phone:301-257-7976
Mailing Address - Fax:
Practice Address - Street 1:1428 SHADY GLEN DR
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-1714
Practice Address - Country:US
Practice Address - Phone:301-257-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide