Basic Information
| Provider Information | |||||||||
| NPI: | 1689733099 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHESAPEAKE MEDICAL SOLUTIONS, PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | YOUR DOCS IN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31516 WINTERPLACE PKWY STE 103 | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218042417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346351 | ||||||||
| FaxNumber: | 4103346352 | ||||||||
| Practice Location | |||||||||
| Address1: | 8163 OCEAN GTWY | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216017145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108220200 | ||||||||
| FaxNumber: | 4108200237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GIANELLE | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4103346351 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20235706 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 11ZMYO | 01 | MD | BLUE CROSS GROUP NUMBER | OTHER | 1000038586 | 05 | DE | MEDICAID | 2145659 | 01 | MD | MAMSI GROUP PROV.NUMBER | OTHER | DD9023 | 01 | MD | RAILROAD MEDICARE GRP NUM | OTHER | 7603709 | 01 | MD | AETNA GROUP PROVIDER NUMB | OTHER | 408316400 | 05 | MD | MEDICAID | 3780 | 01 | DC | BLUE CROSS DC GROUP NUMBE | OTHER |