Provider Demographics
NPI:1275594640
Name:CHESAPEAKE NEUROLOGY AND BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:CHESAPEAKE NEUROLOGY AND BEHAVIORAL HEALTH, LLC
Other - Org Name:CHESAPEAKE NEUROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-535-2500
Mailing Address - Street 1:8191 JENNIFER LN STE 200
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-3197
Mailing Address - Country:US
Mailing Address - Phone:410-535-2500
Mailing Address - Fax:410-535-6030
Practice Address - Street 1:8191 JENNIFER LN STE 200
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-3197
Practice Address - Country:US
Practice Address - Phone:410-535-2500
Practice Address - Fax:410-535-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X, 2084N0400X
MDD0042985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD754991100Medicaid
MDF31944Medicare UPIN
MD754991100Medicaid