Provider Demographics
NPI:1306844436
Name:CHITWOOD, WALTER RANDOLPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RANDOLPH
Last Name:CHITWOOD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3520
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:115 HEART DR DEPT OF
Practice Address - Street 2:EAST CAROLINA HEART INSTITUTE @ ECU DEPT. OF CVS
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8944
Practice Address - Country:US
Practice Address - Phone:252-744-4400
Practice Address - Fax:252-744-3987
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-11-02
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Provider Licenses
StateLicense IDTaxonomies
NC271402086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22370OtherBCBS NC
NC330004174OtherRAILROAD MEDICARE
NC8922370Medicaid
NC8922370Medicaid
NCC83211Medicare UPIN