Provider Demographics
NPI:1700596483
Name:CHUTAMEH, IRENE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CHUTAMEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HERRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1545
Mailing Address - Country:US
Mailing Address - Phone:240-788-5449
Mailing Address - Fax:
Practice Address - Street 1:49 HERRINGTON DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1545
Practice Address - Country:US
Practice Address - Phone:240-788-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health