# MARYLAND INSTITUTE FOR NEUROSCIENCE AND DEVELOPMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295089480
- **Authorized official:** GONZALO LAJE MD (PRESIDENT)
- **Authorized official phone:** (301) 576-6044

## Contact information

- **Practice address:** 5480 WISCONSIN AVE, \#228, CHEVY CHASE, MD 20815-3530
- **Practice address phone:** (301) 576-6044
- **Practice address fax:** (301) 576-1645
- **Mailing address:** 5480 WISCONSIN AVE, \#228, CHEVY CHASE, MD 20815-3530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | D62330 | MD | Yes |

## Other

- **Enumeration date:** 11/09/2012
- **Last updated:** 11/09/2012