Provider Demographics
NPI:1790738771
Name:LACOUNT, CHANDRA R (DO)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:R
Last Name:LACOUNT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12067 BEAUMARIS CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3161
Mailing Address - Country:US
Mailing Address - Phone:757-375-0225
Mailing Address - Fax:
Practice Address - Street 1:10085 RED RUN BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4836
Practice Address - Country:US
Practice Address - Phone:410-821-7775
Practice Address - Fax:410-821-6745
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH63262208100000X, 208D00000X
MDH0063262208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI40702Medicare UPIN
MDK552M370Medicare UPIN