Provider Demographics
NPI:1043253438
Name:CHARING CROSS DIALYSIS LLC
Entity Type:Organization
Organization Name:CHARING CROSS DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-644-9276
Mailing Address - Street 1:MIE EXECUTIVE PARK
Mailing Address - Street 2:5730 EXECUTIVE DRIVE SUITES124
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-747-9356
Mailing Address - Fax:410-747-0603
Practice Address - Street 1:5730 EXECUTIVE DR
Practice Address - Street 2:SUITE 124 - 130
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1760
Practice Address - Country:US
Practice Address - Phone:410-747-9356
Practice Address - Fax:410-747-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212525Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER