Provider Demographics
NPI:1003813585
Name:SMITH, CHESTER L JR (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:L
Last Name:SMITH
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 1:369 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9101
Mailing Address - Country:US
Mailing Address - Phone:570-421-6040
Mailing Address - Fax:570-421-2077
Practice Address - Street 1:369 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9101
Practice Address - Country:US
Practice Address - Phone:570-421-6040
Practice Address - Fax:570-421-2077
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021318E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA083358OtherBLUE SHIELD
PA0006701240001Medicaid
PA0006701240001Medicaid
PA083358OtherBLUE SHIELD
PA083358V8GMedicare PIN