Healthcare Provider Details

I. General information

NPI: 1750305306
Provider Name (Legal Business Name): CHESAPEAKE FOOT AND ANKLE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/03/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030B RITCHIE HWY
PASADENA MD
21122-1084
US

IV. Provider business mailing address

8030B RITCHIE HWY
PASADENA MD
21122-1084
US

V. Phone/Fax

Practice location:
  • Phone: 410-761-0118
  • Fax: 410-761-5118
Mailing address:
  • Phone: 410-761-0118
  • Fax: 410-761-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMD

VIII. Authorized Official

Name: IRA J GOTTLIEB
Title or Position: PODIATRIST/OWNER
Credential: DPM
Phone: 410-761-0118