1750388112 NPI number — CHESAPEAKE PODIATRY GROUP, P.A.

Table of content: (NPI 1750388112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750388112 NPI number — CHESAPEAKE PODIATRY GROUP, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE PODIATRY GROUP, P.A.
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:
1750388112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 WASHINGTON RD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-5845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-876-8637
Provider Business Mailing Address Fax Number:
410-857-5273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 WASHINGTON RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-5845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-876-8637
Provider Business Practice Location Address Fax Number:
410-857-5273
Provider Enumeration Date:
06/30/2005

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
Authorized Official Telephone Number:
410-876-8637

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , 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)

  • Identifier: 492776 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116079 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2700091 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4121973 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: KY26 . This is a "CAREFIRST BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 30463 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 455055 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1243564001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 174130 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 279608200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90209000000 . This is a "PREFERRED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: E351 . This is a "CAREFIRST BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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