Basic Information
| Provider Information | |||||||||
| NPI: | 1538171061 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CHESNUTT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5133 BIOINFORMATICS BUILDING CB 7040 | ||||||||
| Address2: | UNC-CH DEPARTMENT OF OPHTHALMOLOGY | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199665296 | ||||||||
| FaxNumber: | 9199661908 | ||||||||
| Practice Location | |||||||||
| Address1: | 5133 BIOINFORMATICS BUILDING CB 7040 | ||||||||
| Address2: | UNC-CH DEPARTMENT OF OPHTHALMOLOGY | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199665296 | ||||||||
| FaxNumber: | 9199661908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 02/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 9801205 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 8912108 | 05 | NC | MEDICAID |