Provider Demographics
NPI:1205948551
Name:CHESAPEAKE NEUROINSTITUTE LLC
Entity type:Organization
Organization Name:CHESAPEAKE NEUROINSTITUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEASTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-547-9005
Mailing Address - Street 1:300 MEDICAL PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4985
Mailing Address - Country:US
Mailing Address - Phone:757-547-9005
Mailing Address - Fax:757-277-9939
Practice Address - Street 1:300 MEDICAL PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-547-9005
Practice Address - Fax:757-277-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty