Provider Demographics
NPI:1609952456
Name:CHESNUT, CHARLES H III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:CHESNUT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UWMC-ROOSEVELT
Practice Address - Street 2:4245 ROOSEVELT WAY NE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4740
Practice Address - Country:US
Practice Address - Phone:206-598-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011188207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110075127OtherRAILROAD MEDICARE
1153OtherINTERNAL ID-MOTOR VEHICLE ID
WA1152206Medicaid
WA110075127OtherRAILROAD MEDICARE
WA000100887Medicare PIN