Provider Demographics
NPI:1568476745
Name:CHESTON, SALLY B (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:B
Last Name:CHESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SALLY
Other - Middle Name:MURRAY
Other - Last Name:BRIDGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64620
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4620
Mailing Address - Country:US
Mailing Address - Phone:410-328-3037
Mailing Address - Fax:410-328-3040
Practice Address - Street 1:11065 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2998
Practice Address - Country:US
Practice Address - Phone:410-328-3037
Practice Address - Fax:410-328-3040
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD502252085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD793901900Medicaid
MDG31146Medicare UPIN
MD920003237Medicare PIN
MD793901900Medicaid
DC920006341Medicare PIN
DC00A216U99Medicare PIN