Provider Demographics
NPI:1316997364
Name:CHISHOLM, LOUIS RANDOLPH (MD)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:RANDOLPH
Last Name:CHISHOLM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13332 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4210
Mailing Address - Country:US
Mailing Address - Phone:804-794-5598
Mailing Address - Fax:804-378-1954
Practice Address - Street 1:13332 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4210
Practice Address - Country:US
Practice Address - Phone:804-794-5598
Practice Address - Fax:804-378-1954
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA36682OtherOPTIMA
VA540883363OtherVIRGINIA HEALTH NETWORK
VA540883363OtherCHAMPUS-TRICARE
VA540883363OtherPHCS
VA856745OtherMAMSI
VA0100407OtherUNITED HEALTHCARE
VA10527OtherCIGNA
VA540883363OtherGREAT WEST HEALTHCARE
VA5633893Medicaid
VA116043OtherANTHEM
VA539779OtherAETNA
VA540883363OtherFIRST HEATLH/CCN
VA540883363OtherPREFERRED CARE
VA82529OtherSOUTHERN HEALTH
VA540883363OtherFIRST HEATLH/CCN
VA5633893Medicaid
VA82529OtherSOUTHERN HEALTH
VA080126329Medicare PIN
VA016341V28Medicare PIN