Provider Demographics
NPI:1477650554
Name:CHICK, JEFFREY BEECHAM (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BEECHAM
Last Name:CHICK
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:JEFFREY B. CHICK M.D.
Mailing Address - Street 2:1201 PORCHES DR
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409
Mailing Address - Country:US
Mailing Address - Phone:315-579-2560
Mailing Address - Fax:315-579-2561
Practice Address - Street 1:1201 PORCHES DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409
Practice Address - Country:US
Practice Address - Phone:315-727-6084
Practice Address - Fax:315-579-2561
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127721-1174400000X
NY127721207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00570434Medicaid
NY00570434Medicaid
BA1076Medicare PIN