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NPI Code Detail

MEDICARE: CHESAPEAKE DIALYSIS CLINIC LLC

MEDICARE: CHESAPEAKE DIALYSIS CLINIC 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1598354706
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHESAPEAKE DIALYSIS CLINIC LLC
Provider Business Mailing Address
First Line : 8028 RITCHIE HWY STE 210
Second Line :
City : PASADENA
State : MD
Zip : 21122-1075
Country : US
Telephone Number : 410-766-1995
Fax Number :
Provider Business Practice Location Address
First Line : 305 COLLEGE PKWY
Second Line :
City : ARNOLD
State : MD
Zip : 21012-2903
Country : US
Telephone Number : 410-647-0015
Fax Number :
Authorized Official
Title or Position : CFO
Name : BRIAN FINGLASS
Credential :
Telephone Number : 410-766-1995
Provider Enumeration Date : 01/12/2021
Last Update Date : 01/18/2021

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