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General NPI Number Information
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NPI Number | 1760281380
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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 | 03/08/2025
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 410 MALCOLM DR
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City | WESTMINSTER
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State | MD
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Zip | 21157-6160
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Country | US
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Telephone | 410-876-1633
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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 | 443-471-5783
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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