Provider Demographics
NPI:1124072293
Name:VALLEY UROLOGY PC
Entity type:Organization
Organization Name:VALLEY UROLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHESSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-678-3867
Mailing Address - Street 1:136 LINDEN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2818
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:1104 AMHERST ST
Practice Address - Street 2:STE. 204
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3340
Practice Address - Country:US
Practice Address - Phone:540-678-3867
Practice Address - Fax:540-678-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124072293Medicaid
WV3810010693Medicaid
VA7574420001OtherMEDICARE DME
VADF3147OtherRR MEDICARE
=========OtherTAX ID
VA1124072293Medicaid