Provider Demographics
NPI:1487344115
Name:UPPER CHESAPEAKE MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:UPPER CHESAPEAKE MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
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 418150
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 S TOLLGATE RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5234
Practice Address - Country:US
Practice Address - Phone:443-843-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical