Provider Demographics
NPI:1952306995
Name:AMEDIA, CHESTER A (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:A
Last Name:AMEDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4822 MARKET ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2148
Mailing Address - Country:US
Mailing Address - Phone:330-781-6212
Mailing Address - Fax:
Practice Address - Street 1:4822 MARKET ST
Practice Address - Street 2:STE 100
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2148
Practice Address - Country:US
Practice Address - Phone:330-781-6212
Practice Address - Fax:330-953-2041
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35046051A207RN0300X
PAMD033274E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA15028Medicare UPIN