Healthcare Provider Details

I. General information

NPI: 1558531178
Provider Name (Legal Business Name): CHESAPEAKE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9891 GENERAL PULLER HWY
HARTFIELD VA
23071-3122
US

IV. Provider business mailing address

PO BOX 2255
KILMARNOCK VA
22482-2255
US

V. Phone/Fax

Practice location:
  • Phone: 804-776-9221
  • Fax: 804-776-7537
Mailing address:
  • Phone: 804-435-8570
  • Fax: 804-435-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JAMES M HOLMES JR.
Title or Position: CEO/PRESIDENT
Credential:
Phone: 804-435-8535