| Organization Name: | CHESAPEAKE LASER & SKIN CARE |
| NPI Number: | 1164751251 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDGAR FREDERICK PEITHMAN (OWNER) |
| Mailing Address: | 127 Tanners Point Dr Stevensville |
| State: | MD US |
| Postal Code: | 216663701 |
| Phone Number: | 4073280825 |
| Fax Number: | 4073225478 |
| NPI Enumeration Date: | 12/18/2009 |
| NPI Last Update Date: | 12/18/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | C0001172 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |