MEDICARE: PROJECT CHESAPEAKE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	17401	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366990012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT CHESAPEAKE LLC

Provider Business Mailing Address
First Line	:	185 ADMIRAL COCHRANE DR STE 120
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7600
Country	:	US
Telephone Number	:	443-440-5780
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E MAIN ST
Second Line	:	SUITE B
City	:	ELKTON
State	:	MD
Zip	:	21921-5996
Country	:	US
Telephone Number	:	443-406-3234
Fax Number	:	443-378-8538

Authorized Official
Title or Position	:	PARTNER
Name	:	JOSEPH ROGERS
Credential	:
Telephone Number	:	443-440-5780

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	03/26/2024

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Directions to “PROJECT CHESAPEAKE LLC ” Practice Location

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