Provider Demographics
NPI:1972510089
Name:CHESAPEAKE FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:CHESAPEAKE FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-548-3800
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3546
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:676 KINGSBOROUGH SQ
Practice Address - Street 2:STE B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4954
Practice Address - Country:US
Practice Address - Phone:757-548-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080032198Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA080002862Medicare ID - Type UnspecifiedGROUP