Provider Demographics
NPI: | 1942406681 |
---|---|
Name: | CHESAPEAKE UROLOGY ASSOCIATES P.A. |
Entity Type: | Organization |
Organization Name: | CHESAPEAKE UROLOGY ASSOCIATES P.A. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SANFORD |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | SIEGEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 410-581-1600 |
Mailing Address - Street 1: | PO BOX 630664 |
Mailing Address - Street 2: | |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21263-0664 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 21 CROSSROADS DR |
Practice Address - Street 2: | SUITE 450 |
Practice Address - City: | OWINGS MILLS |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21117-5441 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-581-8140 |
Practice Address - Fax: | 410-356-0885 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-06-21 |
Last Update Date: | 2008-08-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 4085540004 | Medicare NSC |