Provider Demographics
NPI:1639534712
Name:CHESAPEAKE MEDCARE SERVICES, INC.
Entity Type:Organization
Organization Name:CHESAPEAKE MEDCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-902-6540
Mailing Address - Street 1:13 BREEZY CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3532
Mailing Address - Country:US
Mailing Address - Phone:410-902-6540
Mailing Address - Fax:410-902-6071
Practice Address - Street 1:13 BREEZY CT
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3532
Practice Address - Country:US
Practice Address - Phone:410-902-6540
Practice Address - Fax:410-902-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3658332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRA3658OtherSTATE LICENSE