Provider Demographics
NPI:1659365690
Name:CHESNUTT, MARTHA J (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:CHESNUTT
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:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:91 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9590
Practice Address - Country:US
Practice Address - Phone:252-451-3200
Practice Address - Fax:252-937-3107
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134ECMedicaid
NCDC6521OtherMEDCOST
NCP00033418OtherRAILROAD MEDICARE
NC134ECOtherBCBSNC
NC3822785OtherCIGNA HEALTHCARE
NC89134ECMedicaid
NC2013358Medicare PIN