Provider Demographics
NPI:1508865189
Name:CHIDESTER, PAUL DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DONALD
Last Name:CHIDESTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:736 N BATTLEFIELD BLVD
Mailing Address - Street 2:CHESAPEAKE GENERAL HOSPITAL-ADMINISTRATION
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4941
Mailing Address - Country:US
Mailing Address - Phone:757-312-6304
Mailing Address - Fax:757-312-6184
Practice Address - Street 1:736 N BATTLEFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-312-6304
Practice Address - Fax:757-312-6184
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101047938207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F27714Medicare UPIN