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General NPI Number Information
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NPI Number | 1033149034
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Entity Type | Organization
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Legal Business Name | MARYVIEW HOSPITAL LLC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 2605 MOSES GRANDY TRL SUITE D
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City | CHESAPEAKE
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State | VA
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Zip | 23323-6712
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Country | US
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Telephone | 757-485-3600
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Fax | 757-485-9458
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Provider Business Mailing Address
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Address Line | 2605 MOSES GRANDY TRL SUITE D
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City | CHESAPEAKE
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State | VA
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Zip | 23323-6712
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Country | US
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Telephone | 757-485-3600
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Fax | 757-485-9458
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Authorized Official
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Title or Position | CFO
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Name | WILBUR GAY
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Credential |
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Telephone | 864-561-7672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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