Provider Demographics
NPI:1518905728
Name:CHESSON, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:CHESSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:136 LINDEN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-678-3867
Mailing Address - Fax:540-678-1440
Practice Address - Street 1:1104 AMHERST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3340
Practice Address - Country:US
Practice Address - Phone:540-678-3867
Practice Address - Fax:540-678-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237237208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010310113Medicaid
WV3810004847Medicaid
VAI22430Medicare UPIN
VA00X072J01Medicare PIN