MEDICARE: JOY CRUZ CHESNUT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	20586	WV
2	207Q00000X	Family Medicine Physician	20586	WV
3	207Q00000X	Family Medicine Physician	35.121478	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00072644	OTHER		RAILROAD MEDICARE
4	P01414936	OTHER	OH	RAILROAD MEDICARE PTAN - MHCPI
5	P00744174	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194793885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY CRUZ CHESNUT MD

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-0449
Country	:	US
Telephone Number	:	740-374-4500
Fax Number	:	740-374-5887

Provider Business Practice Location Address
First Line	:	210 N 7TH ST STE 101
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-2244
Country	:	US
Telephone Number	:	740-376-0490
Fax Number	:	740-376-0438

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/21/2022

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Directions to “ JOY CRUZ CHESNUT MD” Practice Location

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