Healthcare Provider Details

I. General information

NPI: 1417602749
Provider Name (Legal Business Name): CHESAPEAKE HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PLANK BRIDGE ROAD STE B
CAMDEN NC
27921
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 252-331-1829
  • Fax:
Mailing address:
  • Phone: 757-312-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN CRAIG MCDONNELL
Title or Position: VP/CFO
Credential:
Phone: 757-312-3138