Provider Demographics
NPI:1134236037
Name:CHESAPEAKE INTERNISTS LTD
Entity type:Organization
Organization Name:CHESAPEAKE INTERNISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-547-9286
Mailing Address - Street 1:113 GAINSBOROUGH SQ
Mailing Address - Street 2:STE 300
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1713
Mailing Address - Country:US
Mailing Address - Phone:757-547-9286
Mailing Address - Fax:
Practice Address - Street 1:113 GAINSBOROUGH SQ
Practice Address - Street 2:STE 300
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1713
Practice Address - Country:US
Practice Address - Phone:757-547-9286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6049435Medicaid
VA6076629Medicaid
VA5875111Medicaid
VA6030351Medicaid
VA6095003Medicaid
008211C57Medicare ID - Type Unspecified
VAB61959Medicare UPIN
VAB08128Medicare UPIN
VAH59357Medicare UPIN
VAP27728Medicare UPIN
1100020477Medicare ID - Type Unspecified
VA6076629Medicaid
VA6030351Medicaid
VAS77083Medicare UPIN
VA5875111Medicaid