1366639312 NPI number — UPPER CHESAPEAKE ENDOCRINOLOGY ASSOCIATES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366639312 NPI number — UPPER CHESAPEAKE ENDOCRINOLOGY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPPER CHESAPEAKE ENDOCRINOLOGY ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366639312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 UPPER CHESAPEAKE DR
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21014-4339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-643-3340
Provider Business Mailing Address Fax Number:
443-643-3343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2027 PULASKI HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
HAVRE DE GRACE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-843-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRIOLO
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
THOMAS AUGUSTUS
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
443-643-3340

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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