Healthcare Provider Details

I. General information

NPI: 1528395159
Provider Name (Legal Business Name): CHESAPEAKE SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 TIDEWATER COLONY WAY #2A
ANNAPOLIS MD
21401-2107
US

IV. Provider business mailing address

PO BOX 64421
BALTIMORE MD
21264-4421
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9499
  • Fax: 410-571-6486
Mailing address:
  • Phone: 443-481-6476
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GINA MASSOGLIA
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 443-481-6476