Basic Information
| Provider Information | |||||||||
| NPI: | 1205948551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESAPEAKE NEUROINSTITUTE LLC | ||||||||
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| OtherOrganizationName: | ATLANTIC NEUROSURGICAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 MEDICAL PKWY | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575479005 | ||||||||
| FaxNumber: | 7572779939 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MEDICAL PKWY | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575479005 | ||||||||
| FaxNumber: | 7572779939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | HEASTIE | ||||||||
| AuthorizedOfficialFirstName: | KARLA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7575479005 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.