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General NPI Number Information
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NPI Number | 1285221093
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE WELLNESS CENTER
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 818 HIGH ST
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City | CHESTERTOWN
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State | MD
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Zip | 21620-1152
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Country | US
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Telephone | 410-275-8156
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Fax | 877-433-6830
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | CECILTON
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State | MD
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Zip | 21913-0669
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Country | US
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Telephone | 410-275-8156
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Fax | 877-433-6830
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Authorized Official
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Title or Position | CREDENTIALING AGENT
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Name | JANE E HYSKELL
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Credential |
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Telephone | 814-938-8263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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