Provider Demographics
NPI:1801055843
Name:CASTLEBERRY, CHESNEY DAWN (MD)
Entity type:Individual
Prefix:DR
First Name:CHESNEY
Middle Name:DAWN
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3334
Mailing Address - Country:US
Mailing Address - Phone:512-454-1110
Mailing Address - Fax:512-793-8758
Practice Address - Street 1:1110 E 32ND ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-2211
Practice Address - Country:US
Practice Address - Phone:210-722-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS25612080P0202X
MO20150081702080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid