Healthcare Provider Details

I. General information

NPI: 1548750904
Provider Name (Legal Business Name): CHESAPEAKE HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9891 GENERAL PULLER HWY
HARTFIELD VA
23071-3122
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 804-776-9221
  • Fax: 804-776-7537
Mailing address:
  • Phone:
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILBUR GAY
Title or Position: CFO
Credential:
Phone: 864-561-7672