Basic Information
| Provider Information | |||||||||
| NPI: | 1578571238 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHENAULT-OSTROFF UROLOGICAL ASSOC LTD | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4037 TAYLOR RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574831403 | ||||||||
| FaxNumber: | 7574833757 | ||||||||
| Practice Location | |||||||||
| Address1: | 4037 TAYLOR RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574831403 | ||||||||
| FaxNumber: | 7574833757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | AUMAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7574831403 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 0101051804 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 1265424972 | 01 | VA | NPI DR DANIEL E BOYLE JR | OTHER | 7500475 | 05 | VA | MEDICAID | 1134111875 | 01 | VA | NPI DR EDWARD B OSTROFF | OTHER | 1144212051 | 01 | VA | NPI DR JAMES R AUMAN | OTHER | 7500785 | 05 | VA | MEDICAID | 042720 | 01 | VA | BCBS DR JAMES R AUMAN | OTHER | 7550839 | 05 | VA | MEDICAID | 011194 | 01 | VA | BCBS DR EDWARD B OSTROFF | OTHER | 217122 | 01 | VA | BCBS DR DANIEL E BOYLE JR | OTHER |