Provider Demographics
NPI:1679565543
Name:CHESTNUT MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:CHESTNUT MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:EGELHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-734-4206
Mailing Address - Street 1:300 BIRNIE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1107
Mailing Address - Country:US
Mailing Address - Phone:413-734-4206
Mailing Address - Fax:413-737-8882
Practice Address - Street 1:300 BIRNIE AVE
Practice Address - Street 2:STE 102
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1107
Practice Address - Country:US
Practice Address - Phone:413-734-4206
Practice Address - Fax:413-737-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9786694Medicaid