Provider Demographics
NPI:1225003924
Name:CHESEBRO, MARCIA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:JANE
Last Name:CHESEBRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GOVERNORS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-536-5511
Mailing Address - Fax:256-551-4699
Practice Address - Street 1:301 GOVERNORS DRIVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-536-5511
Practice Address - Fax:256-551-4699
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000084825Medicaid
AL000084825Medicaid
C72092Medicare UPIN