Provider Demographics
NPI:1821711425
Name:UPPER CHESAPEAKE RADIATION ONCOLOGY, LLC
Entity Type:Organization
Organization Name:UPPER CHESAPEAKE RADIATION ONCOLOGY, LLC
Other - Org Name:UPPER CHESAPEAKE HEALTH ANCILLARY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:THOMAS AUGUSTUS
Authorized Official - Last Name:PRIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-643-3344
Mailing Address - Street 1:650 MCHENRY RD STE 1300
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2607
Mailing Address - Country:US
Mailing Address - Phone:443-843-6600
Mailing Address - Fax:
Practice Address - Street 1:650 MCHENRY RD STE 1300
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2607
Practice Address - Country:US
Practice Address - Phone:443-843-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty