Provider Demographics
NPI:1275537201
Name:CHEVY, SUTHIPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUTHIPAN
Middle Name:
Last Name:CHEVY
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 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5804
Practice Address - Street 1:650 E MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1023
Practice Address - Country:US
Practice Address - Phone:304-583-8585
Practice Address - Fax:304-583-0129
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-04-30
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
WV10735207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0092794000Medicaid
WV0092794000Medicaid
D83506Medicare UPIN
WV2022235Medicare PIN
WV2022234Medicare PIN
WVCH2022231Medicare ID - Type Unspecified
WVCH2022231Medicare PIN
WV2022233Medicare PIN