Healthcare Provider Details

I. General information

NPI: 1447726195
Provider Name (Legal Business Name): MARRIA MYCHELL CHAMBERS X
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2018
Last Update Date: 10/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12551 JEFFERSON AVE STE 109
NEWPORT NEWS VA
23602-4489
US

IV. Provider business mailing address

PO BOX 1303
HAMPTON VA
23661-0303
US

V. Phone/Fax

Practice location:
  • Phone: 757-602-6332
  • Fax:
Mailing address:
  • Phone: 757-602-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: