Basic Information
| Provider Information | |||||||||
| NPI: | 1194793885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHESNUT | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | CRUZ | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CRUZ | ||||||||
| OtherFirstName: | JOY | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 7403745887 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 N 7TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457502244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403760490 | ||||||||
| FaxNumber: | 7403760438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20586 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 20586 | WV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35.121478 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00072644 | 01 | RAILROAD MEDICARE | OTHER | 1812506000 | 05 | WV | MEDICAID | 2342290 | 05 | OH | MEDICAID | P01414936 | 01 | OH | RAILROAD MEDICARE PTAN - MHCPI | OTHER | P00744174 | 01 | WV | RAILROAD MEDICARE | OTHER |