Provider Demographics
NPI:1962518647
Name:CHEVY CHASE COSMETIC CENTER LLC
Entity type:Organization
Organization Name:CHEVY CHASE COSMETIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FINZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-482-2555
Mailing Address - Street 1:8401 CONNECTICUT AVE
Mailing Address - Street 2:210
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5803
Mailing Address - Country:US
Mailing Address - Phone:240-482-2555
Mailing Address - Fax:240-482-2556
Practice Address - Street 1:8401 CONNECTICUT AVE
Practice Address - Street 2:210
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5803
Practice Address - Country:US
Practice Address - Phone:240-482-2555
Practice Address - Fax:240-482-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02423Medicare PIN