Organization
CHASE BREXTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIVIANE FLORA DICOUM (NURSE PRACTITIONER)
(301) 256-7200
Entity
Organization
Contact information
Practice address
6901 SECURITY BLVD STE 200, BALTIMORE, MD 21244-2412
(410) 837-2050
Mailing address
8604 BRIARWOOD CT, LAUREL, MD 20708-1320
(301) 256-7200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/15/2020
Last updated
04/29/2026
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