Provider Demographics
NPI:1487119046
Name:CHESAPEAKE PHYSICIANS GROUP
Entity type:Organization
Organization Name:CHESAPEAKE PHYSICIANS GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELFENBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-507-9698
Mailing Address - Street 1:1071 MD RT 3 N
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1784
Mailing Address - Country:US
Mailing Address - Phone:410-721-2333
Mailing Address - Fax:
Practice Address - Street 1:1071 MD RT 3 N
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1784
Practice Address - Country:US
Practice Address - Phone:410-721-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS ERGENT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-07
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty