Provider Demographics
NPI:1427119700
Name:CHESTANG, ANTHONY A JR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:CHESTANG
Suffix:JR
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:PO BOX 12366
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-2366
Mailing Address - Country:US
Mailing Address - Phone:205-780-7101
Mailing Address - Fax:205-206-8338
Practice Address - Street 1:832 PRINCETON AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1310
Practice Address - Country:US
Practice Address - Phone:205-206-8461
Practice Address - Fax:205-206-8484
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21119207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-39989OtherBCBS
ALG91272OtherVIVA
ALG91272OtherHEALTHSPRING
ALG91272OtherUNITED HEALTHCARE
AL009942582Medicaid
AL515-39989OtherBCBS
AL051539989Medicare ID - Type Unspecified