Provider Demographics
NPI:1275503807
Name:CHMELEWSKI, WALTER LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:LAWRENCE
Last Name:CHMELEWSKI
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 1:3101 JOHN HUMPHRIES WYND
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5302
Mailing Address - Country:US
Mailing Address - Phone:919-881-8272
Mailing Address - Fax:919-881-2026
Practice Address - Street 1:3101 JOHN HUMPHRIES WYND
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5302
Practice Address - Country:US
Practice Address - Phone:919-881-8272
Practice Address - Fax:919-881-2026
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31789174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0256MOtherMEDICARE GROUP NUMBER
NC7922453Medicaid
NC7922453Medicaid
NCE72588Medicare UPIN