Provider Demographics
NPI:1376635276
Name:EASTERN VIRGINIA SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EASTERN VIRGINIA SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KABZEEL YESUDAS
Authorized Official - Last Name:CHACKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-399-0886
Mailing Address - Street 1:3212 CHURCHLAND BOULEVARD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5206
Mailing Address - Country:US
Mailing Address - Phone:757-399-0886
Mailing Address - Fax:757-399-1191
Practice Address - Street 1:3212 CHURCHLAND BOULEVARD
Practice Address - Street 2:SUITE 8
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5206
Practice Address - Country:US
Practice Address - Phone:757-399-0886
Practice Address - Fax:757-399-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208600000X
2086S0129X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Not Answered208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09477Medicare ID - Type Unspecified