MEDICARE: MARYVIEW HOSPITAL

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1508893892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYVIEW HOSPITAL

Provider Business Mailing Address
First Line	:	4020 RAINTREE RD
Second Line	:	SUITE B
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-3749
Country	:	US
Telephone Number	:	757-465-8450
Fax Number	:	757-465-8616

Provider Business Practice Location Address
First Line	:	4020 RAINTREE RD
Second Line	:	SUITE B
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-3749
Country	:	US
Telephone Number	:	757-465-8450
Fax Number	:	757-465-8616

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL K KERNER
Credential	:
Telephone Number	:	757-673-5929

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	02/01/2012

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Directions to “MARYVIEW HOSPITAL ” Practice Location

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