Provider Demographics
NPI:1780621037
Name:CHESAPEAKE EAR,NOSE,THROAT, SINUS & HEARING CENTER, LLC
Entity type:Organization
Organization Name:CHESAPEAKE EAR,NOSE,THROAT, SINUS & HEARING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-822-1000
Mailing Address - Street 1:29466 PINTAIL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-9323
Mailing Address - Country:US
Mailing Address - Phone:410-820-9119
Mailing Address - Fax:
Practice Address - Street 1:29466 PINTAIL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-9323
Practice Address - Country:US
Practice Address - Phone:410-820-9119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
115PMedicare ID - Type Unspecified