Healthcare Provider Details

I. General information

NPI: 1043700347
Provider Name (Legal Business Name): CHESAPEAKE HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 LIVELY OAKS RD
LIVELY VA
22507
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 804-462-5155
  • Fax: 804-462-5922
Mailing address:
  • Phone: 804-627-5573
  • 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: KIMBERLY M RALSTON
Title or Position: DIRECTOR REIMBURSEMENT
Credential:
Phone: 419-996-5119