Healthcare Provider Details

I. General information

NPI: 1386674091
Provider Name (Legal Business Name): CHESAPEAKE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 SNOW HILL RD
SALISBURY MD
21804
US

IV. Provider business mailing address

804 SNOW HILL RD
SALISBURY MD
21804
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-1104
  • Fax: 410-546-8364
Mailing address:
  • Phone: 410-548-1104
  • Fax: 410-546-8364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1030
License Number StateMD

VIII. Authorized Official

Name: JOHN A BARTKOVICH
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 410-548-2600