Basic Information
| Provider Information | |||||||||
| NPI: | 1932206125 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESAPEAKE HOSPITALISTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 16180 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233286180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573126585 | ||||||||
| FaxNumber: | 7572221708 | ||||||||
| Practice Location | |||||||||
| Address1: | 736 N. BATTLEFIELD BLVD | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573126585 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 11/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | FULP | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7573126585 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 0101056073 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 139607 | 01 | VA | ANTHEM | OTHER | 005857643 | 05 | VA | MEDICAID | CH8520 | 01 | VA | RAILROAD MEDICARE | OTHER |