Provider Demographics
NPI:1184944951
Name:MAUREEN R. CHEVALIER-SEAWELL, MD, PC
Entity type:Organization
Organization Name:MAUREEN R. CHEVALIER-SEAWELL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:CHEVALIER
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-423-6000
Mailing Address - Street 1:801 W LITTLE CREEK RD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2036
Mailing Address - Country:US
Mailing Address - Phone:757-423-6000
Mailing Address - Fax:757-423-0633
Practice Address - Street 1:801 W LITTLE CREEK RD
Practice Address - Street 2:SUITE #104
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2036
Practice Address - Country:US
Practice Address - Phone:757-423-6000
Practice Address - Fax:757-423-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6043623Medicaid
VA6043623Medicaid
VA110000335Medicare PIN