Provider Demographics
NPI:1467439752
Name:DRS MORRES GIANELLE GOERTZEN & ASSOC PA
Entity Type:Organization
Organization Name:DRS MORRES GIANELLE GOERTZEN & ASSOC PA
Other - Org Name:CHESAPEAKE MEDICAL SOLUTIONS TA YOUR DOC'S IN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIANELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-334-6351
Mailing Address - Street 1:509 CALLOWAY ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-3200
Mailing Address - Country:US
Mailing Address - Phone:410-334-6351
Mailing Address - Fax:410-334-6352
Practice Address - Street 1:103 120TH STREET
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842
Practice Address - Country:US
Practice Address - Phone:410-520-0582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20235706207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000038586Medicaid
MDDD9023OtherRAILROAD MEDICARE
MD11ZMYOOtherBLUE CROSS BLUE SHIELD
DC3780OtherBLUE CROSS BLUE SHIELD
MD7603709OtherAETNA
MD408316400Medicaid
MD2145659OtherALLIANCE ONENET
MD111PMedicare PIN
MD5568160001Medicare NSC