Healthcare Provider Details

I. General information

NPI: 1669985032
Provider Name (Legal Business Name): CHOPTANK COMMUNITY HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21374 FOSTER AVE
TILGHMAN MD
21671-1230
US

IV. Provider business mailing address

21374 FOSTER AVE
TILGHMAN MD
21671-1230
US

V. Phone/Fax

Practice location:
  • Phone: 410-886-2222
  • Fax: 833-908-2288
Mailing address:
  • Phone: 108-862-2224
  • Fax: 339-082-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SARA RICH
Title or Position: CEO
Credential:
Phone: 410-479-4306