Provider Demographics
NPI:1225867864
Name:UPPER CHESAPEAKE SURGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:UPPER CHESAPEAKE SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:THOMAS AUGUSTUS
Authorized Official - Last Name:PRIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-643-3344
Mailing Address - Street 1:PO BOX 744918
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4918
Mailing Address - Country:US
Mailing Address - Phone:410-879-9013
Mailing Address - Fax:
Practice Address - Street 1:510 UPPER CHESAPEAKE DR STE 417
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4336
Practice Address - Country:US
Practice Address - Phone:443-643-4438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies