MEDICARE: CHOPTANK COMMUNITY HEALTH SYSTEM INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1437827821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOPTANK COMMUNITY HEALTH SYSTEM INC

Provider Business Mailing Address
First Line	:	3485 GOLDEN HILL RD
Second Line	:
City	:	CHURCH CREEK
State	:	MD
Zip	:	21622-1106
Country	:	US
Telephone Number	:	410-479-4306
Fax Number	:	410-479-1714

Provider Business Practice Location Address
First Line	:	3485 GOLDEN HILL RD
Second Line	:
City	:	CHURCH CREEK
State	:	MD
Zip	:	21622-1106
Country	:	US
Telephone Number	:	410-479-4306
Fax Number	:	410-479-1714

Authorized Official
Title or Position	:	CEO
Name	:	SARA RICH
Credential	:
Telephone Number	:	410-479-4306

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	09/01/2021

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