| |
4124 Chesapeake Square Blvd. Ste. 103 Chesapeake VA 23321 | |
(757) 983-5100 | |
(757) 673-8292 |
Full Name | |
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Speciality | Internal Medicine |
Location | 4124 Chesapeake Square Blvd., Chesapeake, Virginia |
Authorized Official Name and Position | Cindy A Taylor (MANAGER) |
Authorized Official Contact | 7572523344 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4124 Chesapeake Square Blvd. Ste. 103 Chesapeake VA 23321 Ph: (757) 983-5100 | 4124 Chesapeake Square Blvd. Ste. 103 Chesapeake VA 23321 Ph: (757) 983-5100 |
NPI Number | 1659625184 |
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Provider Enumeration Date | 11/06/2012 |
Last Update Date | 11/06/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659625184 | NPI | - | NPPES |
C02033 | Other | VA | MEDICARE GROUP NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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