Provider Demographics
NPI:1770514184
Name:DILALLO, CHESTER ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:ANTHONY
Last Name:DILALLO
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 79757
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0757
Mailing Address - Country:US
Mailing Address - Phone:443-274-2900
Mailing Address - Fax:443-274-2391
Practice Address - Street 1:7500 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 520
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:301-220-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020336207X00000X
MDD0010535207X00000X
DCMD5004207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD117871700Medicaid
DC46950010OtherBCBS DC PROVIDER #
MD200032695OtherRAILROAD MEDICARE
52 1054342OtherTAX ID NUMBER
MD117871700Medicaid
DC46950010OtherBCBS DC PROVIDER #
DC46950010OtherBCBS DC PROVIDER #
MD462*LMedicare ID - Type UnspecifiedMARYLAND MEDICARE GRP#