Provider Demographics
NPI:1275256877
Name:UPPER CHESAPEAKE RADIATION ONCOLOGY, LLC
Entity Type:Organization
Organization Name:UPPER CHESAPEAKE RADIATION ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AM
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DINSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-643-3347
Mailing Address - Street 1:510 UPPER CHESAPEAKE DR STE 412
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4328
Mailing Address - Country:US
Mailing Address - Phone:443-643-3374
Mailing Address - Fax:
Practice Address - Street 1:510 UPPER CHESAPEAKE DR STE 412
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4328
Practice Address - Country:US
Practice Address - Phone:443-643-3374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty