Provider Demographics
NPI:1477682615
Name:ERIC SAMSTAD M.D. LLC
Entity Type:Organization
Organization Name:ERIC SAMSTAD M.D. LLC
Other - Org Name:CHESAPEAKE PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SAMSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-913-3216
Mailing Address - Street 1:600 WYNDHURST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2489
Mailing Address - Country:US
Mailing Address - Phone:410-913-3216
Mailing Address - Fax:443-705-1468
Practice Address - Street 1:600 WYNDHURST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2489
Practice Address - Country:US
Practice Address - Phone:410-913-3216
Practice Address - Fax:443-705-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00611682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty