Provider Demographics
NPI:1316953227
Name:CHESTER, CHARLES J (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:CHESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4248
Mailing Address - Country:US
Mailing Address - Phone:504-231-7465
Mailing Address - Fax:504-834-3101
Practice Address - Street 1:3500 N CAUSEWAY BLVD
Practice Address - Street 2:STE. 1410
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3527
Practice Address - Country:US
Practice Address - Phone:504-838-9919
Practice Address - Fax:504-834-3101
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAR054635 / L0149212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1303291Medicaid
C98732Medicare UPIN
LA5K021Medicare ID - Type Unspecified