Healthcare Provider Details

I. General information

NPI: 1992886568
Provider Name (Legal Business Name): SURYA N CHALLA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PKWY SUITE 200
CHESAPEAKE VA
23320-4985
US

IV. Provider business mailing address

3241 WESTERN BRANCH BLVD
CHESAPEAKE VA
23321-5260
US

V. Phone/Fax

Practice location:
  • Phone: 757-686-3508
  • Fax: 757-686-0541
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SURYA N CHALLA
Title or Position: OWNER
Credential: MD
Phone: 757-686-3508