Basic Information
Provider Information | |||||||||
NPI: | 1851685440 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CHESAPEAKE CARDIOVASCULAR ASSOCIATES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
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Mailing Information | |||||||||
Address1: | 8094 SANDPIPER CIR | ||||||||
Address2: | SUITE O | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 212364907 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4109333017 | ||||||||
FaxNumber: | 4109333019 | ||||||||
Practice Location | |||||||||
Address1: | 3333 N. CALVERT STREET | ||||||||
Address2: | JPB-SUITE 500 | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 21218 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4103665600 | ||||||||
FaxNumber: | 4108894952 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2011 | ||||||||
LastUpdateDate: | 06/23/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
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ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BREWSTER | ||||||||
AuthorizedOfficialFirstName: | ARLENE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
AuthorizedOfficialTelephone: | 4109333017 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207UN0901X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 208G00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |   | 207RC0000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.