Provider Demographics
NPI:1528395159
Name:CHESAPEAKE SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:CHESAPEAKE SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-481-6476
Mailing Address - Street 1:PO BOX 64421
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4421
Mailing Address - Country:US
Mailing Address - Phone:443-481-6476
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2009 TIDEWATER COLONY WAY
Practice Address - Street 2:#2A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2107
Practice Address - Country:US
Practice Address - Phone:410-571-9499
Practice Address - Fax:410-571-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
173692Medicare PIN