MEDICARE: CHESAPEAKE HOSPITAL AUTHORITY

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1619909173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESAPEAKE HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	736 BATTLEFIELD BLVD N
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4941
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2544 BAINBRIDGE BLVD STE B
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324
Country	:	US
Telephone Number	:	757-312-6790
Fax Number	:	757-312-6791

Authorized Official
Title or Position	:	DIRECTOR OF PAYOR CONTRACTING
Name	:	TIMOTHY PAUL GARRETT
Credential	:
Telephone Number	:	757-312-6482

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/02/2019

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Directions to “CHESAPEAKE HOSPITAL AUTHORITY ” Practice Location

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