Provider Demographics
NPI:1215157110
Name:CHESAPEAKE PEDIATRICS INC.
Entity type:Organization
Organization Name:CHESAPEAKE PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUSR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUSHAAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-925-4600
Mailing Address - Street 1:5314 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-925-4600
Mailing Address - Fax:304-925-4601
Practice Address - Street 1:5314 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-925-4600
Practice Address - Fax:304-925-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18109174400000X
174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty