Provider Demographics
NPI:1912928011
Name:PAUL D CHIDESTER MD ET AL
Entity type:Organization
Organization Name:PAUL D CHIDESTER MD ET AL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHIDESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-436-6959
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:300 MEDICAL PKWY
Practice Address - Street 2:SUITE 306
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-410-8791
Practice Address - Fax:757-410-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA194475OtherANTHEM
VA7660794OtherAETNA
VA319574OtherMDIPA
VA15097OtherSENTARA OPTIMA
VA=========OtherUNITED HEALTH CARE
VA7660794OtherAETNA
VAF27714Medicare UPIN
VA=========OtherVIRGINIA HEALTH NETWORK