MEDICARE: CHESAPEAKE PODIATRY GROUP PA

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	335E00000X	Prosthetic/Orthotic Supplier	00898	MD

General Provider Information

NPI Number	:	1497710339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESAPEAKE PODIATRY GROUP PA

Provider Business Mailing Address
First Line	:	25 CROSSROADS DR
Second Line	:	STE 410
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117
Country	:	US
Telephone Number	:	410-363-2233
Fax Number	:	410-363-2235

Provider Business Practice Location Address
First Line	:	910 WASHINGTON RD
Second Line	:	STE D
City	:	WESTMINSTER
State	:	MD
Zip	:	21157
Country	:	US
Telephone Number	:	410-876-8637
Fax Number	:	410-857-5273

Authorized Official
Title or Position	:	PRES OWNER
Name	:	ERIC L DIAMOND
Credential	:	DPM
Telephone Number	:	410-363-2233

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	11/05/2007

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