Basic Information
| Provider Information | |||||||||
| NPI: | 1790862779 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESAPEAKE CARDIOLOGY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 522 IDLEWILD AVE | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216013824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108225571 | ||||||||
| FaxNumber: | 4108223859 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 S LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | CENTREVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216171224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107580626 | ||||||||
| FaxNumber: | 4108223859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 11/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDMAN | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4108225571 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.