Organization
CHESAPEAKE MEDICAL CENTER, PLLC
Active
Organization
CHESAPEAKE MEDICAL CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHALI IBRAHIM-BACHA MD (OWNER)
(304) 720-9595
Entity
Organization
Contact information
Practice address
310 35TH ST SE, SUITE 11, CHARLESTON, WV 25304-1352
(304) 720-9595
(304) 720-9596
Mailing address
PO BOX 4434, CHARLESTON, WV 25364-4434
(304) 720-9595
(304) 720-9596
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19464
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0082173000
—
WV
Enumeration date
11/01/2006
Last updated
08/24/2010
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