Provider Demographics
NPI:1740354182
Name:CHESAPEAKE CARDIAC CARE, P.A.
Entity type:Organization
Organization Name:CHESAPEAKE CARDIAC CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-573-9805
Mailing Address - Street 1:16900 SCIENCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4425
Mailing Address - Country:US
Mailing Address - Phone:410-573-9805
Mailing Address - Fax:410-573-9806
Practice Address - Street 1:16900 SCIENCE DR STE 200
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4425
Practice Address - Country:US
Practice Address - Phone:410-573-9805
Practice Address - Fax:410-573-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD500202800Medicaid
CH2775Medicare PIN
=========OtherEIN