1083810733 NPI number — CHESAPEAKE UROLOGY ASSOCIATES P.A.

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 1083810733 NPI number — CHESAPEAKE UROLOGY ASSOCIATES P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE UROLOGY ASSOCIATES 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:
1083810733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1576 MERRITT BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 11B
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-760-9400
Provider Business Mailing Address Fax Number:
410-787-1911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1576 MERRITT BLVD
Provider Second Line Business Practice Location Address:
SUITE 11B
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21222-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-760-9400
Provider Business Practice Location Address Fax Number:
410-787-1911
Provider Enumeration Date:
06/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIEGEL
Authorized Official First Name:
SANFORD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-581-1600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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