Provider Demographics
NPI:1538144050
Name:DUCKETT, EVA JEANEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:JEANEAL
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:JEANEAL
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 DEFENSE HWY
Mailing Address - Street 2:CHESAPEAKE MEDICAL IMAGING
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7069
Mailing Address - Country:US
Mailing Address - Phone:410-571-0350
Mailing Address - Fax:410-571-0350
Practice Address - Street 1:122 DEFENSE HWY
Practice Address - Street 2:CHESAPEAKE MEDICAL IMAGING
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7069
Practice Address - Country:US
Practice Address - Phone:410-571-0350
Practice Address - Fax:410-571-9348
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD210482085R0202X
MDD00565582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00455075OtherMEDICARE RAILROAD CARRIER
MDP00455075OtherMEDICARE RAILROAD CARRIER
MDG02405V06Medicare PIN