MEDICARE: UPPER CHESAPEAKE PRIMARY CARE,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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1760238091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPER CHESAPEAKE PRIMARY CARE,LLC

Provider Business Mailing Address
First Line	:	900 ELKRIDGE LANDING RD FL 2
Second Line	:
City	:	LINTHICUM
State	:	MD
Zip	:	21090-2924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 UPPER CHESAPEAKE DR STE 312
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-4463
Country	:	US
Telephone Number	:	443-643-2236
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MARCUS THOMAS AUGUSTUS PRIOLO
Credential	:
Telephone Number	:	443-643-3344

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

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