Provider Demographics
NPI:1598795510
Name:CHESTER WALK-IN CENTER
Entity Type:Organization
Organization Name:CHESTER WALK-IN CENTER
Other - Org Name:REMEDY EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-643-4357
Mailing Address - Street 1:1114 DIDONATO DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2663
Mailing Address - Country:US
Mailing Address - Phone:410-643-4357
Mailing Address - Fax:410-643-6940
Practice Address - Street 1:1114 DIDONATO DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2663
Practice Address - Country:US
Practice Address - Phone:410-643-4357
Practice Address - Fax:410-643-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTAX ID NUMBER
MD=========OtherTAX ID NUMBER