Provider Demographics
NPI:1174851711
Name:CHESAPEAKE DIAGNOSTIC IMAGING CENTERS, LLC
Entity type:Organization
Organization Name:CHESAPEAKE DIAGNOSTIC IMAGING CENTERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-965-4151
Mailing Address - Street 1:1554 RIVER BIRCH RUN N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-7500
Mailing Address - Country:US
Mailing Address - Phone:574-796-5415
Mailing Address - Fax:757-965-4168
Practice Address - Street 1:171 KEMPSVILLE RD
Practice Address - Street 2:BUILDING C
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4700
Practice Address - Country:US
Practice Address - Phone:757-671-8500
Practice Address - Fax:757-671-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174851711Medicaid
VA1174851711Medicaid