Healthcare Provider Details

I. General information

NPI: 1902104581
Provider Name (Legal Business Name): UPPER CHESAPEAKE NEURODIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHESAPEAKE BLVD SUITE D
ELKTON MD
21921-6607
US

IV. Provider business mailing address

PO BOX 734
ELKTON MD
21922-0734
US

V. Phone/Fax

Practice location:
  • Phone: 443-245-3452
  • Fax: 443-245-3490
Mailing address:
  • Phone: 302-369-1700
  • Fax: 302-369-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberD0047325
License Number StateMD

VIII. Authorized Official

Name: MR. FRANK FALCO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 302-369-1700