Provider Demographics
NPI:1841206547
Name:CHMIELESKI, ROBERT MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARSHALL
Last Name:CHMIELESKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:225 NORTH MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4984
Mailing Address - Country:US
Mailing Address - Phone:860-583-7741
Mailing Address - Fax:860-585-5417
Practice Address - Street 1:225 NORTH MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4984
Practice Address - Country:US
Practice Address - Phone:860-583-7741
Practice Address - Fax:860-585-5417
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT018258207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B84423Medicare UPIN