is a Specialist in Chesapeake, Virginia. practices all healthcare services and medical treatments related to Specialist. The NPI Number for is 1659483022. The last update date is .
's current location address is 516 Innovation Dr, Chesapeake, Virginia. You can contact this provider via phone number 7574360011 and fax number 7574360075. The mailing address for is 516 Innovation Dr, Chesapeake, Virginia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 516 Innovation Dr, Chesapeake, Virginia |
| Phone Number | 7574360011 |
| Fax Number | 7574360075 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1659483022 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 516 Innovation Dr |
|---|---|
| City | Chesapeake |
| State | Virginia (VA) |
| Post Code | 233203866 |
| Phone Number | 7574360011 |
| Fax Number | 7574360075 |
Provider's Primary Taxonomy Detail
| Speciality | Specialist |
|---|---|
| Taxonomy | 174400000X |
| Licence No | 101056722 |
|
Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 6309895 | VA | -- | |
| 461049 | VA | ANTHEM BCBS | |
| 2248749C | NC | CIGNA MEDICARE | |
| 56198 | VA | OPTIMA/SENTARA | |
| 5088230 | VA | AETNA |
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