Organization
CAPE CHARLES MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK GREGORY CLARKE (PRESIDENT)
(757) 331-1422
Entity
Organization
Contact information
Practice address
216 MASON AVE, CAPE CHARLES, VA 23310-3200
(757) 331-1422
(757) 331-1624
Mailing address
216 MASON AVE, CAPE CHARLES, VA 23310-3200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101038467
VA
Other
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
Enumeration date
10/03/2006
Last updated
12/01/2009
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