MEDICARE: CHESAPEAKE BAY PAIN MEDICINE, P.C.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1285686295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESAPEAKE BAY PAIN MEDICINE, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 2546
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23450-2546
Country	:	US
Telephone Number	:	757-340-3489
Fax Number	:	757-340-4278

Provider Business Practice Location Address
First Line	:	329 EDWIN DR
Second Line	:	SUITE 100
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4522
Country	:	US
Telephone Number	:	757-464-2006
Fax Number	:	757-464-2226

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL EDWARD GAUTHIER
Credential	:	M.D.
Telephone Number	:	757-464-2006

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/27/2021

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