Provider Demographics
NPI:1700181724
Name:M. NICK CHEHREH, M. D., P. A.
Entity Type:Organization
Organization Name:M. NICK CHEHREH, M. D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M.
Authorized Official - Middle Name:NICK
Authorized Official - Last Name:CHEHREH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:301-262-4555
Mailing Address - Street 1:3327 SUPERIOR LN
Mailing Address - Street 2:STE 205
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1922
Mailing Address - Country:US
Mailing Address - Phone:301-262-4555
Mailing Address - Fax:301-262-8921
Practice Address - Street 1:3327 SUPERIOR LN
Practice Address - Street 2:STE 205
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1922
Practice Address - Country:US
Practice Address - Phone:301-262-4555
Practice Address - Fax:301-262-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0003912261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D09283Medicare PIN
DO9283Medicare PIN