Provider Demographics
NPI:1750654158
Name:CHESAPEAKE PODIATRY GROUP, PA
Entity Type:Organization
Organization Name:CHESAPEAKE PODIATRY GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-876-8637
Mailing Address - Street 1:910 WASHINGTON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5845
Mailing Address - Country:US
Mailing Address - Phone:410-876-8637
Mailing Address - Fax:410-857-5273
Practice Address - Street 1:910 WASHINGTON RD
Practice Address - Street 2:SUITE D
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5845
Practice Address - Country:US
Practice Address - Phone:410-876-8637
Practice Address - Fax:410-857-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD898213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT59872Medicare UPIN