Provider Demographics
NPI:1598905333
Name:CHESAPEAKE ORTHOPAEDIC & SPORTS MEDICINE CENTER
Entity Type:Organization
Organization Name:CHESAPEAKE ORTHOPAEDIC & SPORTS MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-768-5555
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5884
Mailing Address - Country:US
Mailing Address - Phone:410-768-5555
Mailing Address - Fax:410-799-1441
Practice Address - Street 1:7556 TEAGUE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076
Practice Address - Country:US
Practice Address - Phone:410-768-5555
Practice Address - Fax:410-799-1441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESAPEAKE ORTHOPAEDIC & SPORTS MEDICINE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-05
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD912851400Medicaid
MD912851400Medicaid