Provider Demographics
NPI:1003851551
Name:CHESAPEAKE CARDIO-THORACIC SURGERY
Entity type:Organization
Organization Name:CHESAPEAKE CARDIO-THORACIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-554-6550
Mailing Address - Street 1:201 E UNIVERSITY PARKWAY
Mailing Address - Street 2:JPB SUITE LL08
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2895
Mailing Address - Country:US
Mailing Address - Phone:410-554-6550
Mailing Address - Fax:410-554-6534
Practice Address - Street 1:3333 N CALVERT STREET
Practice Address - Street 2:SUITE LL08
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2895
Practice Address - Country:US
Practice Address - Phone:410-554-6550
Practice Address - Fax:410-554-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1403431OtherBCBS OF PA
180072OtherCOVENTRY HEALTHCARE
362173OtherALLIANCE PPO
MD020202900Medicaid
MDT035OtherBCBS FEP
MDLT13MIOtherBCBS
227538OtherKAISER PERMANENTE
362173OtherMAMSI