Healthcare Provider Details

I. General information

NPI: 1245115211
Provider Name (Legal Business Name): CHESAPEAKE UROLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 LUBRANO DR STE 201
ANNAPOLIS MD
21401-7567
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-0090
  • Fax: 410-573-0097
Mailing address:
  • Phone: 410-581-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANFORD JAY SIEGEL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 410-581-1600