1679528038 NPI number — CHESAPEAKE NEUROLOGY SERVICES, 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 1679528038 NPI number — CHESAPEAKE NEUROLOGY SERVICES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE NEUROLOGY SERVICES, 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:
1679528038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1602 NEWPORT GAP PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19808-6208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-633-5840
Provider Business Mailing Address Fax Number:
302-633-5844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 W HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21921-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-392-7044
Provider Business Practice Location Address Fax Number:
410-620-0055
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MELNICK
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
410-392-7044

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000021421 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: # 1M53CH . This is a "CAREFIRST GROUP NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: DA4922 . This is a "MEDICARE RR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 406618900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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