Provider Demographics
NPI:1710952908
Name:CHADWELL, CHRISTOPHER L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:L
Last Name:CHADWELL
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:PO BOX 632832
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2832
Mailing Address - Country:US
Mailing Address - Phone:513-585-2410
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:SUITE 6162
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-2410
Practice Address - Fax:513-585-1057
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076822207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64050594Medicaid
OH110226736OtherRR MEDICARE
OH2251852Medicaid
IN200377710Medicaid
OH4052951Medicare PIN
OHH39310Medicare UPIN