Healthcare Provider Details

I. General information

NPI: 1649467788
Provider Name (Legal Business Name): CHESAPEAKE UROLOGY ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 WASHINGTON RD SUITE 215
WESTMINSTER MD
21157-5750
US

IV. Provider business mailing address

PO BOX 630664
BALTIMORE MD
21263-0664
US

V. Phone/Fax

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

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: M.D.
Phone: 410-581-1600