Individual
DR. JOHN H CHIDESTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
254 W. LANCASTER AVE, SUITE 2, MALVERN, PA 19355-3087
(610) 644-5040
(610) 640-9170
Mailing address
254 W. LANCASTER AVE, SUITE 2, MALVERN, PA 19355-3087
(610) 644-5040
(610) 640-9170
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD-019797-E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02598600
IDENPENDENCE BLUE CROSS
PA
01
—
055590
PERSONAL CHOICE PROVIDER
PA
01
—
1754466
HIGHMARK GROUP ID #
PA
01
—
3646
AETNA PROVIDER NUMBER
PA
Enumeration date
09/13/2005
Last updated
03/04/2008
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