Healthcare Provider Details

I. General information

NPI: 1528261674
Provider Name (Legal Business Name): JASON MCHUGH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 TAYLOR RD STE 100
CHESAPEAKE VA
23321-2246
US

IV. Provider business mailing address

2613 TAYLOR RD STE 100
CHESAPEAKE VA
23321-2246
US

V. Phone/Fax

Practice location:
  • Phone: 757-673-5680
  • Fax: 757-483-3075
Mailing address:
  • Phone: 757-673-5680
  • Fax: 757-483-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0102202865
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: