Healthcare Provider Details

I. General information

NPI: 1265637359
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 STONER AVE SUITE 301
WESTMINSTER MD
21157-5698
US

IV. Provider business mailing address

295 STONER AVE SUITE 301
WESTMINSTER MD
21157-5698
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-1633
  • Fax: 410-840-2100
Mailing address:
  • Phone: 410-876-1633
  • Fax: 410-840-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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