Provider Demographics
NPI:1699894857
Name:CHESAPEAKE PEDIATRIC & ADOLESCENT ASSOCIATES, PA
Entity type:Organization
Organization Name:CHESAPEAKE PEDIATRIC & ADOLESCENT ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-543-1616
Mailing Address - Street 1:106 MILFORD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6959
Mailing Address - Country:US
Mailing Address - Phone:410-543-1616
Mailing Address - Fax:410-543-8497
Practice Address - Street 1:106 MILFORD ST STE 201
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6959
Practice Address - Country:US
Practice Address - Phone:410-543-1616
Practice Address - Fax:410-543-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD283952OtherCOVENTRY HEALTHCARE
MD430401201Medicaid
MDS758CHOtherBLUE CROSS BLUE SHIELD
MD826426OtherPRIORITY PARTNERS
MDG113-0000OtherCAREFIRST
MD213297OtherUNITED HEALTHCARE
MDG113OtherBLUE CROSS BLUE CHOICE
MD188017OtherAMERIGROUP COMMUNITY CARE
MD430401200OtherMARYLAND PHYSICIANS CARE
MD430401200Medicaid
MD4560463OtherAETNA