Provider Demographics
NPI:1942507629
Name:UPPER CHESAPEAKE ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:UPPER CHESAPEAKE ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
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:443-643-3340
Mailing Address - Street 1:510 UPPER CHESAPEAKE DR
Mailing Address - Street 2:#417
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4328
Mailing Address - Country:US
Mailing Address - Phone:443-643-3130
Mailing Address - Fax:443-643-3133
Practice Address - Street 1:510 UPPER CHESAPEAKE DR
Practice Address - Street 2:#417
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4328
Practice Address - Country:US
Practice Address - Phone:443-643-3130
Practice Address - Fax:443-643-3133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPPER CHESAPEAKE MEDICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-16
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty