| Chesapeake Medical Center, Pllc | |
|
310 35th St Se Suite 11 Charleston WV 25304-1352 | |
| (304) 720-9595 | |
| (304) 720-9596 |
| Full Name | Chesapeake Medical Center, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 310 35th St Se, Charleston, West Virginia |
| Authorized Official Name and Position | Ghali Ibrahim-bacha (OWNER) |
| Authorized Official Contact | 3047209595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chesapeake Medical Center, Pllc Po Box 4434 Charleston WV 25364-4434 Ph: (304) 720-9595 | Chesapeake Medical Center, Pllc 310 35th St Se Suite 11 Charleston WV 25304-1352 Ph: (304) 720-9595 |
| NPI Number | 1477630952 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/24/2010 |
| Medicare PECOS PAC ID | 5890785851 |
|---|---|
| Medicare Enrollment ID | O20100326000531 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477630952 | NPI | - | NPPES |
| 0082173000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 19464 (West Virginia) | Primary |
| Provider Name | Ghali Ibrahim-bacha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366540833 PECOS PAC ID: 6507856572 Enrollment ID: I20040514000047 |
| Provider Name | Shawnna D Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033397401 PECOS PAC ID: 0143277749 Enrollment ID: I20050406000161 |
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