Provider Demographics
NPI:1659476711
Name:NAKAMURA, CHESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:
Last Name:NAKAMURA
Suffix:
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 1:4 COULTER RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1122
Mailing Address - Country:US
Mailing Address - Phone:315-462-0447
Mailing Address - Fax:
Practice Address - Street 1:4 COULTER RD
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-462-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212285207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7313293OtherAETNA
NY000915846004OtherHEALTH NOW
NY2593316OtherGHI
NY01910883Medicaid
NYP010212285OtherBLUE CHOICE
NY810600635OtherTAX ID
NYEMPIREOther810600635
P010212285OtherBLUE CHOICE
101791BJOtherPREFERRED CARE
NY212285OtherPREFERRED CARE
P00018133OtherRAILROAD MEDICARE
P020212285OtherROCHESTER BLUE SHIELD
NY361866500OtherWORKERS COMPENSATION