Healthcare Provider Details

I. General information

NPI: 1598761355
Provider Name (Legal Business Name): UPPER CHESAPEAKE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UPPER CHESAPEAKE DR
BEL AIR MD
21014-4324
US

IV. Provider business mailing address

500 UPPER CHESAPEAKE DR
BEL AIR MD
21014-4324
US

V. Phone/Fax

Practice location:
  • Phone: 443-643-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number12006
License Number StateMD

VIII. Authorized Official

Name: MARCUS THOMAS AUGUSTUS PRIOLO
Title or Position: CFO
Credential:
Phone: 443-643-3340