Provider Demographics
NPI:1194793885
Name:CHESNUT, JOY CRUZ (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:CRUZ
Last Name:CHESNUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:210 N 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2244
Practice Address - Country:US
Practice Address - Phone:740-376-0490
Practice Address - Fax:740-376-0438
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20586207P00000X, 207Q00000X
OH35.121478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00072644OtherRAILROAD MEDICARE
WV1812506000Medicaid
OH2342290Medicaid
OHP01414936OtherRAILROAD MEDICARE PTAN - MHCPI
WVP00744174OtherRAILROAD MEDICARE
OHP01414936OtherRAILROAD MEDICARE PTAN - MHCPI
OHH216210Medicare PIN
WV4092774Medicare PIN
OH2342290Medicaid
4092772Medicare ID - Type Unspecified