Provider Demographics
NPI:1316482318
Name:MARYVIEW HOSPITAL
Entity type:Organization
Organization Name:MARYVIEW HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIRICONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-281-8301
Mailing Address - Street 1:908 EDEN WAY N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3336
Mailing Address - Country:US
Mailing Address - Phone:757-738-1350
Mailing Address - Fax:757-413-5450
Practice Address - Street 1:908 EDEN WAY N
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3336
Practice Address - Country:US
Practice Address - Phone:757-738-1350
Practice Address - Fax:757-413-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05149Medicare PIN