Provider Demographics
NPI:1124024773
Name:CHA, JAI C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAI
Middle Name:C
Last Name:CHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1425 BLUE HERON RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1714
Mailing Address - Country:US
Mailing Address - Phone:757-481-5314
Mailing Address - Fax:
Practice Address - Street 1:736 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-312-6118
Practice Address - Fax:757-312-6235
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101026695207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC45830Medicare UPIN