Provider Demographics
NPI:1760584312
Name:CHESNICK, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:CHESNICK
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 1:101 GREENWOOD AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2614
Mailing Address - Country:US
Mailing Address - Phone:215-379-8458
Mailing Address - Fax:215-379-8458
Practice Address - Street 1:H-42 OMEGA DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-738-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAC327502085B0100X, 2085N0904X
IL0361075192085B0100X, 2085N0904X, 2085U0001X
MDD00508902085N0904X, 2085U0001X
PAMD028271E2085R0202X, 2085U0001X
IL036.1080412085R0202X
MDD00573152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010093970019Medicaid
MDS382002OtherBCBS
PA0100939706OtherAMERICHOICE
PA1128712OtherKEYSTONE MERCY
MD2120960000OtherAMERIHEALTH
PA300122389OtherPALMETTO
MD300137800OtherRAILROAD MEDICARE
MD300137801OtherRAILROAD MEDICARE
MD349M480FMedicaid
MD53048801OtherBLUE SHIELD
PACH173132OtherBCBS
MD336261209Medicaid
ILC32750OtherTRICARE
MDC32750OtherTRICARE
MD53048801OtherBLUE SHIELD
PA300122389OtherPALMETTO
MD336261209Medicaid
ILL96845Medicare PIN
PACH173132OtherBCBS