Healthcare Provider Details

I. General information

NPI: 1396768404
Provider Name (Legal Business Name): DOUGLAS H CHESSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 OMNI BLVD STE 303
NEWPORT NEWS VA
23606-4434
US

IV. Provider business mailing address

12420 WARWICK BLVD 7-C
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 757-232-8769
  • Fax: 757-232-8875
Mailing address:
  • Phone: 757-595-3900
  • Fax: 757-595-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number0101023814
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101023814
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number0101023814
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: