Provider Demographics
NPI:1902104581
Name:UPPER CHESAPEAKE NEURODIAGNOSTICS
Entity Type:Organization
Organization Name:UPPER CHESAPEAKE NEURODIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-369-1700
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21922-0734
Mailing Address - Country:US
Mailing Address - Phone:302-369-1700
Mailing Address - Fax:302-369-1122
Practice Address - Street 1:101 CHESAPEAKE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6607
Practice Address - Country:US
Practice Address - Phone:443-245-3452
Practice Address - Fax:443-245-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047325204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty