Provider Demographics
NPI:1639240872
Name:MARTY, CHELSY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHELSY
Middle Name:
Last Name:MARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 3RD ST S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6096
Mailing Address - Country:US
Mailing Address - Phone:904-249-6110
Mailing Address - Fax:904-249-6119
Practice Address - Street 1:3200 3RD ST S
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6096
Practice Address - Country:US
Practice Address - Phone:904-249-6110
Practice Address - Fax:904-249-6119
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85647207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47975YOtherMEDICARE
ND71599Medicare ID - Type Unspecified
FL47975YOtherMEDICARE