Provider Demographics
NPI:1992980577
Name:TON THAT CHIEU
Entity type:Organization
Organization Name:TON THAT CHIEU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:DR
Authorized Official - First Name:TON
Authorized Official - Middle Name:THAT
Authorized Official - Last Name:CHIEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-445-4100
Mailing Address - Street 1:7505 NEW HAMPSHIRE AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6972
Mailing Address - Country:US
Mailing Address - Phone:301-445-4100
Mailing Address - Fax:301-445-2167
Practice Address - Street 1:7505 NEW HAMPSHIRE AVE STE 310
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6972
Practice Address - Country:US
Practice Address - Phone:301-445-4100
Practice Address - Fax:301-445-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23429261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
4170OtherAETNA
MD81140OtherMAMSI
MD0680OtherBLUE CHOICE