1750661203 NPI number — CHESAPEAKE WEIGHT LOSS CONSULTANTS PLLC

Table of content: (NPI 1750661203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750661203 NPI number — CHESAPEAKE WEIGHT LOSS CONSULTANTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE WEIGHT LOSS CONSULTANTS PLLC
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:
6
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:
1750661203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHESAPEAKE WEIGHT LOSS CONSULTANTS, PLLC
Provider Second Line Business Mailing Address:
221 MOUNT PLEASANT ROAD SUITE A-1
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23322-4155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-312-9444
Provider Business Mailing Address Fax Number:
757-447-3500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 KINGSBOROUGH SQ
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-312-9444
Provider Business Practice Location Address Fax Number:
757-447-3500
Provider Enumeration Date:
08/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CHASTANET
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
757-312-9444

Provider Taxonomy Codes

  • Taxonomy code: 207RB0002X , with the licence number:  0101043938 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 0101222153 , 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)





Copyright © 2007-2025 www.npivalidator.com