Healthcare Provider Details

I. General information

NPI: 1760584312
Provider Name (Legal Business Name): RICHARD CHESNICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H-42 OMEGA DRIVE
NEWARK DE
19713
US

IV. Provider business mailing address

101 GREENWOOD AVE STE 150
JENKINTOWN PA
19046-2614
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-1700
  • Fax:
Mailing address:
  • Phone: 215-379-8458
  • Fax: 215-379-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberC32750
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number036107519
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberC32750
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberD0050890
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number036107519
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD028271E
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.108041
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD028271E
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberD0050890
License Number StateMD
# 10
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number036107519
License Number StateIL
# 11
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0057315
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: