Healthcare Provider Details

I. General information

NPI: 1235334335
Provider Name (Legal Business Name): CHESAPEAKE UROLOGY ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8322 BELLONA AVE SUITE 202
TOWSON MD
21204-2012
US

IV. Provider business mailing address

PO BOX 630664
BALTIMORE MD
21263-0664
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-6310
  • Fax: 410-825-6320
Mailing address:
  • Phone: 410-825-6310
  • Fax: 410-825-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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: SANFORD J SIEGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 410-581-1600