Healthcare Provider Details

I. General information

NPI: 1528038817
Provider Name (Legal Business Name): CHARLES CHANDLER ASHBY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MEDICAL PKWY FL 2
CHESAPEAKE VA
23320-0302
US

IV. Provider business mailing address

PO BOX 11314
BELFAST ME
04915-4004
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-4047
  • Fax: 757-410-0339
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101032057
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: