Organization · NPI-2

Chesapeake Institute Of Anti-Aging Medicine

Internal Medicine · Timonium, MD

NPI number1104832864
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1104832864
Entity type
Organization (NPI-2)
Legal business name
Chesapeake Institute Of Anti-Aging Medicine
Organization subpart
No
Enumeration date
Aug 1, 2006
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal MedicineD0022699MDYes

Practice location

2219 York Rd
Suite 301
Timonium, MD 21093-3139

Phone 443-901-2118 · Fax 443-901-2119

Mailing address

2219 York Rd
Suite 301
Timonium, MD 21093-3139

Phone 443-901-2118 · Fax 443-901-2119

Authorized official

Randolph G. Whipps
Owner
4439012118

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