Provider Demographics
NPI:1740514967
Name:CHEVERLY WOMEN HEALTHCARE INC.
Entity type:Organization
Organization Name:CHEVERLY WOMEN HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-322-2127
Mailing Address - Street 1:6005 LANDOVER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1145
Mailing Address - Country:US
Mailing Address - Phone:301-322-2127
Mailing Address - Fax:301-322-9770
Practice Address - Street 1:6005 LANDOVER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1145
Practice Address - Country:US
Practice Address - Phone:301-322-2127
Practice Address - Fax:301-322-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026819174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD191927Medicare UPIN