Basic Information
| Provider Information | |||||||||
| NPI: | 1225233315 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHESAPEAKE UROLOGY ASSOCIATES P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 630664 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212630664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105811600 | ||||||||
| FaxNumber: | 4105811603 | ||||||||
| Practice Location | |||||||||
| Address1: | 1645 LIBERTY RD | ||||||||
| Address2: | |||||||||
| City: | ELDERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217846521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105811600 | ||||||||
| FaxNumber: | 4105811603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | SIEGEL | ||||||||
| AuthorizedOfficialFirstName: | SANFORD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4105811600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.