MEDICARE: ANGELA L CHEZEM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C55848	CA
2	207Q00000X	Family Medicine Physician	0101233484	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275621666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA L CHEZEM MD

Provider Business Mailing Address
First Line	:	24801 PINEBROOK RD STE 110
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4113
Country	:	US
Telephone Number	:	703-722-2500
Fax Number	:	703-327-1850

Provider Business Practice Location Address
First Line	:	24801 PINEBROOK RD STE 110
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4113
Country	:	US
Telephone Number	:	703-722-2500
Fax Number	:	703-327-1850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	11/09/2022

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