Provider Demographics
NPI:1811142771
Name:CHESAPEAKE PAIN CENTER, LLC
Entity type:Organization
Organization Name:CHESAPEAKE PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-484-2828
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-0404
Mailing Address - Country:US
Mailing Address - Phone:443-484-2828
Mailing Address - Fax:443-484-2831
Practice Address - Street 1:2012 SOUTH TOLLGATE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5901
Practice Address - Country:US
Practice Address - Phone:443-484-2828
Practice Address - Fax:443-484-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW11478880261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD109766OtherJOHNS HOPKINS HEALTH CARE
MD5571764OtherAETNA
MD003003100Medicaid
MD541744325OtherCOVENTRY
MD541744325OtherTRICARE
DCK8170001OtherCAREFIRST BCBS
MD220CCHOtherCAREFIRST BCBS
MD10229730OtherAMERIGROUP
MD003003100Medicaid