Healthcare Provider Details

I. General information

NPI: 1730130790
Provider Name (Legal Business Name): CHESAPEAKE PODIATRY GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WASHINGTON RD STE D
WESTMINSTER MD
21157
US

IV. Provider business mailing address

25 CROSSROADS DR STE 410
OWINGS MILLS MD
21117
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-8637
  • Fax: 410-857-5273
Mailing address:
  • Phone: 410-363-2233
  • Fax: 410-363-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ERIC L DIAMOND
Title or Position: PRES OWNER
Credential: DPM
Phone: 410-363-2233