Chesapeake Urology Associates, LLC
Organization Active NPI Urology Physician · Brandywine, MD
NPI 1679398366 · NPPES record last updated Mar 8, 2025
Key facts
- NPI
- 1679398366
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- Legal business name
- CHESAPEAKE UROLOGY ASSOCIATES, LLC
- Practice address
- 7704 Matapeake Business Dr Ste 310
Brandywine, MD 20613-3046 - Phone
- (301) 868-0202
- NPI assigned
- Nov 19, 2024
- Organization subpart
- No
Authorized official
- Name
- Sanford Jay Siegel, MD
- Title
- President
- Phone
- (410) 581-1600
Other NPIs on the same Medicare enrollment 9
Corporate family (same tax ID) 39
Practitioners 5
-
Joyce M Freidly, P.A.-C.
-
Ally Gordon, PA-C
-
Tara Janen Mahan, PA
-
Sara Tamashasky, P.A.-C.
-
Sanford Jay Siegel, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D1027982 | Chesapeake Urology Associates | Certificate of waiver | Feb 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111216000464 | DC | Part B Supplier - Clinic/Group Practice | 4789673393 |
Receives reassigned benefits from 110 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Germantown, MD; Wheaton, MD; Silver Spring, MD; Rockville, MD; Potomac, MD; Oxon Hill, MD; Largo, MD; Gaithersburg, MD… |
National Provider Directory
- Tax ID family
- Chesapeake Urol Assoc LLC
Locations
7704 Matapeake Business Dr
Ste 300
Brandywine, MD 20613
Phone (301) 645-8838
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | Yes |
Addresses
Primary practice location
7704 Matapeake Business Dr Ste 310
Brandywine, MD 20613-3046
Mailing address
10200 Grand Central Ave Ste 220
Owings Mills, MD 21117-4366
Phone (443) 471-5839
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 276600151 | Medicaid | MD |
Other providers in Brandywine, MD
- Careone Home Care
- Thomas Cestare
- Charmaine T Cha Camp
- Emily Cha
- Menghan Chen
- Giancarlo Massimo Chiancone
- Wei-Yi Chiang
- Salman Chohan
- Daniel Chukwuebuka Chukwuemeka
- Candice Clark
All providers in Brandywine, MD · Urology Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.