Healthcare Provider Details

I. General information

NPI: 1376521773
Provider Name (Legal Business Name): DAVID M CHESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HAWLEY LN STE 1102
STRATFORD CT
06614-1204
US

IV. Provider business mailing address

99 HAWLEY LN STE 1102
STRATFORD CT
06614-1204
US

V. Phone/Fax

Practice location:
  • Phone: 203-666-8145
  • Fax: 203-456-9793
Mailing address:
  • Phone: 203-666-8145
  • Fax: 203-456-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ9978
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberQ9978
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number025310
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: