Healthcare Provider Details

I. General information

NPI: 1679778773
Provider Name (Legal Business Name): CHESAPEAKE UROLOGY ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W HIGH ST SUITE 304
ELKTON MD
21921-5529
US

IV. Provider business mailing address

PO BOX 630664
BALTIMORE MD
21263-0664
US

V. Phone/Fax

Practice location:
  • Phone: 800-589-5954
  • Fax: 410-392-5938
Mailing address:
  • Phone: 800-589-5954
  • Fax: 410-392-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SANFORD J SIEGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 410-581-1600