Provider Demographics
NPI:1891871448
Name:HUMPHREY, CHESTER B (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:B
Last Name:HUMPHREY
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 33440
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06150-3440
Mailing Address - Country:US
Mailing Address - Phone:860-522-7181
Mailing Address - Fax:860-278-3357
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 325
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-7181
Practice Address - Fax:860-278-3357
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012722208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061028513OtherUNITED HEALTHCARE
CTP00136938OtherRAILROAD MEDICARE
CTP387299OtherOXFORD HEALTHPLAN
CT001127224Medicaid
CT010012722CT02OtherBLUECARE FAMILY PLAN
CT1340836OtherCIGNA HEALTHPLAN
CT052312OtherCONNECTICARE
CTOV7424OtherHEALTHNET
CT010012722CT02OtherANTHEM BLUE CROSS
CT061028513OtherCOMMUNITY HEALTH NTWK
CT2362874OtherAETNA HMO
CT4112202OtherAETNA HEALTHPLAN
CTB38970Medicare UPIN
CT001127224Medicaid