Healthcare Provider Details

I. General information

NPI: 1750661203
Provider Name (Legal Business Name): CHESAPEAKE WEIGHT LOSS CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 KINGSBOROUGH SQ SUITE D
CHESAPEAKE VA
23320-4988
US

IV. Provider business mailing address

CHESAPEAKE WEIGHT LOSS CONSULTANTS, PLLC 221 MOUNT PLEASANT ROAD SUITE A-1
CHESAPEAKE VA
23322-4155
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-9444
  • Fax: 757-447-3500
Mailing address:
  • Phone: 757-312-9444
  • Fax: 757-447-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number0101043938
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101222153
License Number StateVA

VIII. Authorized Official

Name: DR. RACHEL IRENE CHASTANET
Title or Position: CO-OWNER
Credential: MD
Phone: 757-312-9444