Basic Information
| Provider Information | |||||||||
| NPI: | 1558301218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHASTENEY | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E LANCASTER AVE STE 660 | ||||||||
| Address2: | LANKENAU MEDICAL BUILDING EAST | ||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190963450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108967550 | ||||||||
| FaxNumber: | 6108967914 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E LANCASTER AVE STE 660 | ||||||||
| Address2: | LANKENAU MEDICAL BUILDING EAST | ||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190963450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108967550 | ||||||||
| FaxNumber: | 6108967914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 12/01/2010 | ||||||||
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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 | 207V00000X | MD031663-E | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4089061 | 01 | PA | AETNA | OTHER | CH35689 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0052756000 | 01 | PA | INDEPENDENCA BLUE CROSS | OTHER |