Healthcare Provider Details

I. General information

NPI: 1548085137
Provider Name (Legal Business Name): CHESAPEAKE UROLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MOUNT HERMON RD
SALISBURY MD
21804-5109
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-2133
  • Fax:
Mailing address:
  • Phone: 443-471-5839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANFORD JAY SIEGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 410-581-1600