Provider Demographics
NPI:1932777554
Name:CHASTEEN, JESSE TODD (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:TODD
Last Name:CHASTEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSE
Other - Middle Name:TODD
Other - Last Name:CHASTEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JESSE T CHASTEEN MD
Mailing Address - Street 1:305 HODGES AND MILLER RD
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-9024
Mailing Address - Country:US
Mailing Address - Phone:828-406-5876
Mailing Address - Fax:
Practice Address - Street 1:301 FISHER ST
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534-2508
Practice Address - Country:US
Practice Address - Phone:828-406-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
NE35218208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
1456959993OtherMILITARY COMMON ACCESS CARD