MEDICARE: MARYVIEW HOSPITAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033149034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYVIEW HOSPITAL LLC

Provider Business Mailing Address
First Line	:	2605 MOSES GRANDY TRL
Second Line	:	SUITE D
City	:	CHESAPEAKE
State	:	VA
Zip	:	23323-6712
Country	:	US
Telephone Number	:	757-485-3600
Fax Number	:	757-485-9458

Provider Business Practice Location Address
First Line	:	2605 MOSES GRANDY TRL
Second Line	:	SUITE D
City	:	CHESAPEAKE
State	:	VA
Zip	:	23323-6712
Country	:	US
Telephone Number	:	757-485-3600
Fax Number	:	757-485-9458

Authorized Official
Title or Position	:	CFO
Name	:	WILBUR GAY
Credential	:
Telephone Number	:	864-561-7672

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/24/2020

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Directions to “MARYVIEW HOSPITAL LLC ” Practice Location

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