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General NPI Number Information
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NPI Number | 1760681308
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Entity Type | Individual
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Provider Name | CHESTER THEODORE MAYERS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 3001 WALNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-386-3556
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Fax |
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Provider Business Mailing Address
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Address Line | 5 BUNNING DR
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City | VOORHEES
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State | NJ
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Zip | 08043
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Country | US
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Telephone | 856-751-2190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD045493L
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License Number State | PA
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