Provider Demographics
NPI:1083827828
Name:CHESAPEAKE EAR, NOSE & THROAT, P.A.
Entity type:Organization
Organization Name:CHESAPEAKE EAR, NOSE & THROAT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-356-2626
Mailing Address - Street 1:23 CROSSROADS DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5420
Mailing Address - Country:US
Mailing Address - Phone:410-356-2626
Mailing Address - Fax:
Practice Address - Street 1:23 CROSSROADS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5420
Practice Address - Country:US
Practice Address - Phone:410-356-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD429981700Medicaid
MDE400OtherFEP GRP #
MDK291OtherBCBS GROUP NUMBER
MDE400OtherBLUE CHOICE GRP #
MDE400OtherBLUE CHOICE GRP #