Healthcare Provider Details

I. General information

NPI: 1851685440
Provider Name (Legal Business Name): CHESAPEAKE CARDIOVASCULAR ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N. CALVERT STREET JPB-SUITE 500
BALTIMORE MD
21218
US

IV. Provider business mailing address

8094 SANDPIPER CIR SUITE O
BALTIMORE MD
21236-4907
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-5600
  • Fax: 410-889-4952
Mailing address:
  • Phone: 410-933-3017
  • Fax: 410-933-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: ARLENE BREWSTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 410-933-3017