Provider Demographics
NPI:1871787077
Name:BETHESDA PHYSICIANS PC
Entity type:Organization
Organization Name:BETHESDA PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/SECRETARY OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHRETIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-656-4010
Mailing Address - Street 1:8120 WOODMONT AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2743
Mailing Address - Country:US
Mailing Address - Phone:301-656-4010
Mailing Address - Fax:301-654-2319
Practice Address - Street 1:8120 WOODMONT AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2743
Practice Address - Country:US
Practice Address - Phone:301-656-4010
Practice Address - Fax:301-654-2319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45225207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00656Medicare UPIN