1982886537 NPI number — CHESAPEAKE PULMONARY ASSOCIATES, LLC

Table of content: (NPI 1982886537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982886537 NPI number — CHESAPEAKE PULMONARY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE PULMONARY 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:
6
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:
1982886537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 297
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVRE DE GRACE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21078-0297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-453-5055
Provider Business Mailing Address Fax Number:
443-453-5054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2303 BEL AIR RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
FALLSTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21047-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-453-5055
Provider Business Practice Location Address Fax Number:
443-453-5054
Provider Enumeration Date:
12/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BURKE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
443-453-5055

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  D0047746 , 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: 404853900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 528PS670 . This is a "MEDICARE ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: M41063 . This is a "CDS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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