Provider Demographics
NPI:1427094903
Name:CHADWICK, DEBORAH L (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HOSPITAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9104
Mailing Address - Country:US
Mailing Address - Phone:304-351-1755
Mailing Address - Fax:
Practice Address - Street 1:1401 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9104
Practice Address - Country:US
Practice Address - Phone:304-351-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42253208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000589169OtherANTHEM BCBS
KY000000614208OtherANTHEM BCBS
OH2275505Medicaid
KY64040728Medicaid
KYP00648377OtherRR MEDICARE
COC490088Medicare PIN
KY00762001Medicare PIN