Healthcare Provider Details

I. General information

NPI: 1821065079
Provider Name (Legal Business Name): CHESAPEAKE ONCOLOGY HEMATOLOGY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 HOSPITAL DR
GLEN BURNIE MD
21061-5805
US

IV. Provider business mailing address

305 HOSPITAL DR
GLEN BURNIE MD
21061-5805
US

V. Phone/Fax

Practice location:
  • Phone: 410-761-9896
  • Fax: 411-761-2250
Mailing address:
  • Phone: 410-761-9896
  • Fax: 410-761-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATANYA RENETTE MOORE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 410-761-9896