Provider Demographics
NPI:1376504621
Name:CHITWOOD, MARY BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:CHITWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:WEICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3619 RICHARDSON SQUARE DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010
Mailing Address - Country:US
Mailing Address - Phone:636-717-6776
Mailing Address - Fax:314-525-4055
Practice Address - Street 1:3619 RICHARDSON SQUARE DR
Practice Address - Street 2:SUITE 170
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010
Practice Address - Country:US
Practice Address - Phone:636-717-6776
Practice Address - Fax:314-525-4055
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI14592Medicare UPIN
1376504621Medicare PIN