Provider Demographics
NPI:1124172606
Name:CHIDESTER, KARA E (MD)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:E
Last Name:CHIDESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:ELIZABETH
Other - Last Name:CHIDESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1975 GUILFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4300
Mailing Address - Country:US
Mailing Address - Phone:614-869-0139
Mailing Address - Fax:614-869-0140
Practice Address - Street 1:1975 GUILFORD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-4300
Practice Address - Country:US
Practice Address - Phone:614-869-0139
Practice Address - Fax:614-869-0140
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2750590Medicaid
OHH549500Medicare PIN