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NPI 1215629100 · Sports Medicine (Preventive Medicine) Physician · Chesapeake, VA
Provider details
- NPI number
- 1215629100
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Preventive Medicine) PhysicianAllopathic & Osteopathic Physicians
- Sex
- Male
- Sole proprietor
- Yes
- License
- 2081S0010X (VA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
604 Appalachian Ct
Chesapeake, VA 23320-1620
Phone: (843) 231-9865
Approximate (ZIP-level) locationGet directions
Mailing address
604 Appalachian Ct
Chesapeake, VA 23320-1620
Registry dates
- Enumerated
- 2023-05-22
- Last updated
- 2023-05-22
- Certified
- 2023-05-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.