Provider Demographics
NPI:1063497329
Name:CHELEMER, SCOTT B (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:CHELEMER
Suffix:
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 1:1768 BUSINESS CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5359
Mailing Address - Country:US
Mailing Address - Phone:786-785-1514
Mailing Address - Fax:786-672-6006
Practice Address - Street 1:1768 BUSINESS CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5359
Practice Address - Country:US
Practice Address - Phone:800-762-9244
Practice Address - Fax:786-672-6006
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06391900207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04911368Medicaid
NJ7228805Medicaid
PA102450866-0001Medicaid