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General NPI Number Information
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NPI Number | 1528516879
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE BAY SURGICAL ASSISTANTS
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 6814 CHAND CT
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City | BALTIMORE
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State | MD
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Zip | 21237-3869
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Country | US
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Telephone | 410-868-1629
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Fax |
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Provider Business Mailing Address
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Address Line | 6814 CHAND CT
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City | BALTIMORE
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State | MD
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Zip | 21237-3869
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Country | US
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Telephone | 410-868-1629
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT
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Name | LOUIS KALISCH
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Credential | SA-C
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Telephone | 410-868-1629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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