Basic Information
Provider Information
NPI: 1568611903
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHREST
FirstName: ROBERT
MiddleName: BASIL
NamePrefix: DR.
NameSuffix: JR.
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2000 EOFF ST
Address2:  
City: WHEELING
State: WV
PostalCode: 260033823
CountryCode: US
TelephoneNumber: 3042340123
FaxNumber:  
Practice Location
Address1: 2000 EOFF ST
Address2:  
City: WHEELING
State: WV
PostalCode: 260033823
CountryCode: US
TelephoneNumber: 3042340123
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/10/2008
LastUpdateDate: 09/10/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X2355WVY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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