Basic Information
| Provider Information | |||||||||
| NPI: | 1790738771 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LACOUNT | ||||||||
| FirstName: | CHANDRA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12067 BEAUMARIS CT | ||||||||
| Address2: | |||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206023161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573750225 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10085 RED RUN BLVD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211174836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108217775 | ||||||||
| FaxNumber: | 4108216745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | H63262 | MD | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208D00000X | H0063262 | MD | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | H63262 | MD | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.