Provider Demographics
NPI:1548201551
Name:FOX, CHESTER (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:BLDG CC ROOM 151
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-6206
Mailing Address - Fax:716-898-4750
Practice Address - Street 1:1315 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208
Practice Address - Country:US
Practice Address - Phone:716-332-3797
Practice Address - Fax:716-332-4247
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY131558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00452171Medicaid
NY00452171Medicaid
B81718Medicare UPIN