Provider Demographics
NPI:1811139900
Name:CHESAPEAKE ENT/PLASTIC FACIAL SURGERY
Entity type:Organization
Organization Name:CHESAPEAKE ENT/PLASTIC FACIAL SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-A
Authorized Official - Phone:410-398-6570
Mailing Address - Street 1:PO BOX 8571
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-8571
Mailing Address - Country:US
Mailing Address - Phone:410-398-4679
Mailing Address - Fax:410-620-3686
Practice Address - Street 1:111 W HIGH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5529
Practice Address - Country:US
Practice Address - Phone:410-398-6570
Practice Address - Fax:410-398-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01023231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407609500Medicaid