# CAPE CHARLES MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124112198
- **Authorized official:** MARK GREGORY CLARKE (PRESIDENT)
- **Authorized official phone:** (757) 331-1422

## Contact information

- **Practice address:** 216 MASON AVE, CAPE CHARLES, VA 23310-3200
- **Practice address phone:** (757) 331-1422
- **Practice address fax:** (757) 331-1624
- **Mailing address:** 216 MASON AVE, CAPE CHARLES, VA 23310-3200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101038467 | VA | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 12/01/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 005642434 | — | VA |
| 05 | — | 005642451 | — | VA |
| 01 | — | 454260 | ANTHEM GROUP \# | VA |
| 01 | — | C08218 | MEDICARE GROUP PTAN NUMBER | VA |
| 01 | — | CJ8918 | GROUP\# | VA |