Provider Demographics
NPI:1134383235
Name:UMS CHESAPEAKE LITHOTRIPSY, LLC
Entity type:Organization
Organization Name:UMS CHESAPEAKE LITHOTRIPSY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-653-7201
Mailing Address - Street 1:115 SUDBROOK LN
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4130
Mailing Address - Country:US
Mailing Address - Phone:410-653-7201
Mailing Address - Fax:
Practice Address - Street 1:115 SUDBROOK LN
Practice Address - Street 2:SUITE 207
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-4130
Practice Address - Country:US
Practice Address - Phone:410-653-7201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM385261QL0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy