Provider Demographics
NPI:1578697629
Name:UPPER CHESAPEAKE HEALTH REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:UPPER CHESAPEAKE HEALTH REHABILITATION SERVICES, LLC
Other - Org Name:UPPER CHESAPEAKE CENTER FOR SPORTS MEDICINE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:THOMAS AUGUSTUS
Authorized Official - Last Name:PRIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-643-3340
Mailing Address - Street 1:500 UPPER CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4324
Mailing Address - Country:US
Mailing Address - Phone:443-643-3719
Mailing Address - Fax:443-643-3606
Practice Address - Street 1:615 W MACPHAIL RD STE 210
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4469
Practice Address - Country:US
Practice Address - Phone:443-843-3313
Practice Address - Fax:443-843-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12006273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit