Provider Demographics
NPI:1447726195
Name:CHAMBERS, MARRIA MYCHELL X
Entity type:Individual
Prefix:
First Name:MARRIA
Middle Name:MYCHELL
Last Name:CHAMBERS
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-0303
Mailing Address - Country:US
Mailing Address - Phone:757-602-6332
Mailing Address - Fax:
Practice Address - Street 1:12551 JEFFERSON AVE STE 109
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4489
Practice Address - Country:US
Practice Address - Phone:757-602-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA$$$$$$$$$Medicaid