Provider Demographics
NPI:1285801407
Name:CHASTAIN, IRYNA G (MD)
Entity type:Individual
Prefix:MRS
First Name:IRYNA
Middle Name:G
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:IRYNA
Other - Middle Name:GENNAGYEVNA
Other - Last Name:CHASTAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5 NEPONSET STREET
Mailing Address - Street 2:WOT 2ND FL, STE C203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-852-0600
Mailing Address - Fax:508-368-3146
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083584AMedicaid
MA110083584AMedicaid