Healthcare Provider Details

I. General information

NPI: 1124857214
Provider Name (Legal Business Name): CHESAPEAKE DIGESTIVE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BRANDERMILL BLVD STE 330
GAMBRILLS MD
21054-1604
US

IV. Provider business mailing address

2401 BRANDERMILL BLVD STE 330
GAMBRILLS MD
21054-1604
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-4887
  • Fax:
Mailing address:
  • Phone: 410-224-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential: CEO
Phone: 786-530-3820