Provider Demographics
NPI:1306890454
Name:CHESSER, RICHARD S (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:CHESSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 PARK AVE SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2417
Mailing Address - Country:US
Mailing Address - Phone:803-641-0049
Mailing Address - Fax:803-641-0810
Practice Address - Street 1:118 PARK AVE SW
Practice Address - Street 2:SUITE 100
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2417
Practice Address - Country:US
Practice Address - Phone:803-641-0049
Practice Address - Fax:803-641-0810
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC15803207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC158037Medicaid
SC158037Medicaid
SCF549800281Medicare UPIN