Provider Demographics
NPI:1972586188
Name:CHEDID, SOLLY SILWAN (MD)
Entity type:Individual
Prefix:
First Name:SOLLY
Middle Name:SILWAN
Last Name:CHEDID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SILWAN
Other - Middle Name:
Other - Last Name:CHEDID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:2809 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5301
Practice Address - Country:US
Practice Address - Phone:228-809-5251
Practice Address - Fax:228-809-5255
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS29039207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09438250Medicaid
MA3952422OtherAETNA US HEALTH
MA470499OtherTUFTS
MAJ29192OtherBLUE CROSS BLUE SHIELD
TX1558108-02Medicaid
MAAA39630OtherHARVARD PILGRIM
MAAA39630OtherHARVARD PILGRIM
MA2107716Medicaid
MA8A3049Medicare ID - Type Unspecified