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General NPI Number Information
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NPI Number | 1992845283
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 8028 RITCHIE HWY STE 106
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City | PASADENA
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State | MD
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Zip | 21122-1020
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Country | US
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Telephone | 410-761-0118
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Fax | 410-761-5118
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Provider Business Mailing Address
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Address Line | 8030B RITCHIE HWY
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City | PASADENA
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State | MD
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Zip | 21122-1084
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Country | US
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Telephone | 410-761-0118
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Fax | 410-761-5118
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRA J GOTTLIEB
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Credential | DPM
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Telephone | 410-761-0118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A1076
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License Number State | MD
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