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General NPI Number Information
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NPI Number | 1093445546
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Entity Type | Organization
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Legal Business Name | BLUE CHESAPEAKE MEDICAL
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 12836 MACBETH FARM LN
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1555
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Country | US
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Telephone | 144-387-8409
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Fax |
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Provider Business Mailing Address
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Address Line | 12836 MACBETH FARM LN
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1555
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Country | US
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Telephone | 144-387-8409
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WEI LU
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Credential | MD
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Telephone | 443-878-4098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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