Healthcare Provider Details

I. General information

NPI: 1992845283
Provider Name (Legal Business Name): CHESAPEAKE AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/17/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8028 RITCHIE HWY STE 106
PASADENA MD
21122-1020
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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1076
License Number StateMD

VIII. Authorized Official

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