Individual
DR. MARK EWING CHISAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3901 TREYBURN DR, SUITE B, WILLIAMSBURG, VA 23185-2891
(757) 220-4900
(757) 565-5328
Mailing address
856 J CLYDE MORRIS BLVD, SUITE A, NEWPORT NEWS, VA 23601-1318
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
0101054200
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053381251
—
VA
Enumeration date
01/23/2006
Last updated
10/03/2013
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