Organization
CHESAPEAKE CENTER FOR COSMETIC AND PLASTIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAD E. GRENGA M.D. (DIRECTOR)
(757) 673-5900
Entity
Organization
Contact information
Practice address
5818 HARBOUR VIEW BLVD, SUFFOLK, VA 23435-3315
(757) 673-5900
(757) 673-5905
Mailing address
5818 HARBOUR VIEW BLVD, SUFFOLK, VA 23435-3315
(757) 673-5900
(757) 673-5905
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101041085
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118152
BLUE CROSS
VA
01
—
15906
OPTIMASENTARA
VA
05
—
6901395
—
VA
Enumeration date
04/17/2007
Last updated
02/23/2012
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