Provider Demographics
NPI:1457521080
Name:CHESAPEAKE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CHESAPEAKE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-435-8535
Mailing Address - Street 1:PO BOX 2255
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-2255
Mailing Address - Country:US
Mailing Address - Phone:804-435-8570
Mailing Address - Fax:804-435-8037
Practice Address - Street 1:8152 NORTHUMBERLAND HWY
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473-3309
Practice Address - Country:US
Practice Address - Phone:804-580-7200
Practice Address - Fax:804-580-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05380Medicare PIN