Healthcare Provider Details

I. General information

NPI: 1194974360
Provider Name (Legal Business Name): CHESAPEAKE NEUROLOGY AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28105 THREE NOTCH RD # 1C
MECHANICSVILLE MD
20659-3235
US

IV. Provider business mailing address

28105 THREE NOTCH RD # 1C
MECHANICSVILLE MD
20659-3235
US

V. Phone/Fax

Practice location:
  • Phone: 301-290-1510
  • Fax: 301-290-1574
Mailing address:
  • Phone: 301-290-1510
  • Fax: 301-290-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0060886
License Number StateMD

VIII. Authorized Official

Name: AHMED KAFAJI
Title or Position: OWNER/ MD
Credential: MD
Phone: 301-290-1510