Provider Demographics
NPI:1124019682
Name:CHILES, WALTER W III (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:W
Last Name:CHILES
Suffix:III
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 1:25 CROSSROADS DR STE 306
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9245 PARK WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4425
Practice Address - Country:US
Practice Address - Phone:865-690-3811
Practice Address - Fax:865-694-7621
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39479208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0347510001OtherMEDICARE NSC
TN3329829Medicaid
P00233826Medicare PIN
TN0347510001OtherMEDICARE NSC
3329829Medicare ID - Type Unspecified