Provider Demographics
NPI:1649467788
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:410-876-1633
Mailing Address - Fax:
Practice Address - Street 1:826 WASHINGTON RD
Practice Address - Street 2:SUITE 215
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5750
Practice Address - Country:US
Practice Address - Phone:410-876-1633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4085440026Medicare NSC