Provider Demographics
NPI:1326067562
Name:CHESAPEAKE PHYSICAL MEDICINE,LLC
Entity Type:Organization
Organization Name:CHESAPEAKE PHYSICAL MEDICINE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-535-8180
Mailing Address - Street 1:120 HOSPITAL RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4022
Mailing Address - Country:US
Mailing Address - Phone:410-535-8180
Mailing Address - Fax:410-535-8325
Practice Address - Street 1:120 HOSPITAL RD
Practice Address - Street 2:SUITE100
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4022
Practice Address - Country:US
Practice Address - Phone:410-535-8180
Practice Address - Fax:410-535-8325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD754MMedicare ID - Type Unspecified