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General NPI Number Information
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NPI Number | 1619792744
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE UROLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 12200 KILN CT STE A
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City | BELTSVILLE
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State | MD
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Zip | 20705-1324
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Country | US
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Telephone | 443-471-5852
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Fax |
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Provider Business Mailing Address
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Address Line | 10200 GRAND CENTRAL AVE STE 220
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4366
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Country | US
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Telephone | 443-471-5839
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANFORD JAY SIEGEL
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Credential | MD
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Telephone | 410-581-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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