1518936848 NPI number — CHESAPEAKE PODIATRY GROUP PA

Table of content: (NPI 1518936848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518936848 NPI number — CHESAPEAKE PODIATRY GROUP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE PODIATRY GROUP PA
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:
1518936848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 CROSSROADS DR
Provider Second Line Business Mailing Address:
STE 410
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-5421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-363-2233
Provider Business Mailing Address Fax Number:
410-363-2235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 CROSSROADS DR
Provider Second Line Business Practice Location Address:
STE 410
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-363-2233
Provider Business Practice Location Address Fax Number:
410-363-2235
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIAMOND
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
410-363-2233

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  00898 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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