MEDICARE: HERBERT G CHISSELL III M.D.

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	2084F0202X	Forensic Psychiatry Physician	D0018519	MD
2	2084P0800X	Psychiatry Physician	D0018519	MD

General Provider Information

NPI Number	:	1982659728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERBERT G CHISSELL III M.D.

Provider Business Mailing Address
First Line	:	330 SUFFOLK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-2521
Country	:	US
Telephone Number	:	410-467-7448
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 SETON DR
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-1854
Country	:	US
Telephone Number	:	301-723-5030
Fax Number	:	301-723-1480

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	06/28/2026

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