1083818017 NPI number — THE CHESAPEAKE CENTER, INC.

Table of content: DR. HERBERT MATTHEW SPANN DDS (NPI 1922889757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083818017 NPI number — THE CHESAPEAKE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHESAPEAKE CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083818017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9110 ASPENPARK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LORTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22079-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
703-924-0126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6506 LOISDALE RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22150-1824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-924-4122
Provider Business Practice Location Address Fax Number:
703-924-0126
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FORE
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
HR GENERALIST
Authorized Official Telephone Number:
703-924-4122

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202004710 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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