Basic Information
| Provider Information | |||||||||
| NPI: | 1528395159 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESAPEAKE SURGICAL ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64421 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816476 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2009 TIDEWATER COLONY WAY | ||||||||
| Address2: | #2A | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214012107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105719499 | ||||||||
| FaxNumber: | 4105716486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2009 | ||||||||
| LastUpdateDate: | 12/20/2011 | ||||||||
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| AuthorizedOfficialLastName: | MASSOGLIA | ||||||||
| AuthorizedOfficialFirstName: | GINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4434816476 | ||||||||
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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 | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.