Provider Demographics
NPI:1427074004
Name:AHLSTROM, PROMISE A (MD)
Entity type:Individual
Prefix:DR
First Name:PROMISE
Middle Name:A
Last Name:AHLSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6931 ARLINGTON RD STE 340
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5231
Mailing Address - Country:US
Mailing Address - Phone:202-363-0300
Mailing Address - Fax:202-363-7251
Practice Address - Street 1:6931 ARLINGTON RD STE 340
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5231
Practice Address - Country:US
Practice Address - Phone:202-363-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37733208000000X
DCMD17595208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics