Organization
MARYLAND INSTITUTE FOR NEUROSCIENCE AND DEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GONZALO LAJE MD (PRESIDENT)
(301) 576-6044
Entity
Organization
Contact information
Practice address
5480 WISCONSIN AVE, #228, CHEVY CHASE, MD 20815-3530
(301) 576-6044
(301) 576-1645
Mailing address
5480 WISCONSIN AVE, #228, CHEVY CHASE, MD 20815-3530
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
D62330
MD
Other
Enumeration date
11/09/2012
Last updated
11/09/2012
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