MEDICARE: UPPER CHESAPEAKE SURGICAL ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1225867864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPER CHESAPEAKE SURGICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 744918
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-4918
Country	:	US
Telephone Number	:	410-879-9013
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 UPPER CHESAPEAKE DR STE 417
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-4336
Country	:	US
Telephone Number	:	443-643-4438
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MARCUS THOMAS AUGUSTUS PRIOLO
Credential	:
Telephone Number	:	443-643-3344

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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