Provider Demographics
NPI:1558301218
Name:CHASTENEY, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:CHASTENEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E LANCASTER AVE STE 660
Mailing Address - Street 2:LANKENAU MEDICAL BUILDING EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-896-7550
Mailing Address - Fax:610-896-7914
Practice Address - Street 1:100 E LANCASTER AVE STE 660
Practice Address - Street 2:LANKENAU MEDICAL BUILDING EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-896-7550
Practice Address - Fax:610-896-7914
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD031663-E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4089061OtherAETNA
PACH35689OtherHIGHMARK BLUE SHIELD
PA0052756000OtherINDEPENDENCA BLUE CROSS
PA4089061OtherAETNA
PA0052756000OtherINDEPENDENCA BLUE CROSS