Provider Demographics
NPI:1124488408
Name:CHESAPEAKE FAMILY PRACTICE, INC.
Entity type:Organization
Organization Name:CHESAPEAKE FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-251-6246
Mailing Address - Street 1:1201 PEMBERTON DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2501
Mailing Address - Country:US
Mailing Address - Phone:443-978-7170
Mailing Address - Fax:
Practice Address - Street 1:1201 PEMBERTON DR STE 2A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2501
Practice Address - Country:US
Practice Address - Phone:443-978-7170
Practice Address - Fax:443-978-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181859302R00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization