Basic Information
| Provider Information | |||||||||
| NPI: | 1366639312 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPPER CHESAPEAKE ENDOCRINOLOGY ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 UPPER CHESAPEAKE DR | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436433340 | ||||||||
| FaxNumber: | 4436433343 | ||||||||
| Practice Location | |||||||||
| Address1: | 2027 PULASKI HIGHWAY | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438436100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2007 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | PRIOLO | ||||||||
| AuthorizedOfficialFirstName: | MARCUS | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS AUGUSTUS | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4436433340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.