Healthcare Provider Details

I. General information

NPI: 1700858040
Provider Name (Legal Business Name): CHESAPEAKE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 LOISDALE RD STE 300
SPRINGFIELD VA
22150-1824
US

IV. Provider business mailing address

6506 LOISDALE RD STE 300
SPRINGFIELD VA
22150-1824
US

V. Phone/Fax

Practice location:
  • Phone: 703-924-4100
  • Fax: 703-922-0638
Mailing address:
  • Phone: 703-924-4100
  • Fax: 703-922-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA A ROGERS
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: MS CCC SLP
Phone: 703-924-4148