Provider Demographics
NPI:1992845283
Name:CHESAPEAKE AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:CHESAPEAKE AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-768-5800
Mailing Address - Street 1:8028 RITCHIE HWY
Mailing Address - Street 2:SUITE 100-102
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1075
Mailing Address - Country:US
Mailing Address - Phone:410-768-5800
Mailing Address - Fax:410-768-5806
Practice Address - Street 1:8028 RITCHIE HWY
Practice Address - Street 2:SUITE 100-102
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1075
Practice Address - Country:US
Practice Address - Phone:410-768-5800
Practice Address - Fax:410-768-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1076261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDZZ40Medicare PIN