Healthcare Provider Details

I. General information

NPI: 1376635276
Provider Name (Legal Business Name): EASTERN VIRGINIA SURGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 CHURCHLAND BOULEVARD SUITE 8
CHESAPEAKE VA
23321-5206
US

IV. Provider business mailing address

3212 CHURCHLAND BOULEVARD SUITE 8
CHESAPEAKE VA
23321-5206
US

V. Phone/Fax

Practice location:
  • Phone: 757-399-0886
  • Fax: 757-399-1191
Mailing address:
  • Phone: 757-399-0886
  • Fax: 757-399-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KABZEEL YESUDAS CHACKO
Title or Position: PRESIDENT OWNER
Credential: M.D.
Phone: 757-399-0886