Healthcare Provider Details

I. General information

NPI: 1073340907
Provider Name (Legal Business Name): CHESAPEAKE PEDIATRIC & ADOLESCENT ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BROAD ST STE 201
BERLIN MD
21811-1054
US

IV. Provider business mailing address

106 MILFORD ST STE 201
SALISBURY MD
21804-6959
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-1616
  • Fax: 410-543-8497
Mailing address:
  • Phone: 410-543-1616
  • Fax: 410-543-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM WATSON
Title or Position: CREDENTIALING
Credential:
Phone: 410-543-1616