Provider Demographics
NPI:1053175851
Name:MC PELVIC HEALTH, LLC
Entity type:Organization
Organization Name:MC PELVIC HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAULS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-956-6411
Mailing Address - Street 1:14101 MANORVALE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2521
Mailing Address - Country:US
Mailing Address - Phone:301-956-6411
Mailing Address - Fax:
Practice Address - Street 1:14101 MANORVALE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-2521
Practice Address - Country:US
Practice Address - Phone:301-956-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center