MEDICARE: CHESAPEAKE PODIATRY GROUP, PA

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	213ES0131X	Foot Surgery Podiatrist	898	MD

General Provider Information

NPI Number	:	1750654158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESAPEAKE PODIATRY GROUP, PA

Provider Business Mailing Address
First Line	:	910 WASHINGTON RD
Second Line	:	SUITE D
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5845
Country	:	US
Telephone Number	:	410-876-8637
Fax Number	:	410-857-5273

Provider Business Practice Location Address
First Line	:	910 WASHINGTON RD
Second Line	:	SUITE D
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5845
Country	:	US
Telephone Number	:	410-876-8637
Fax Number	:	410-857-5273

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERIC LEE DIAMOND
Credential	:	DPM
Telephone Number	:	410-876-8637

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2012

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