Organization
CHARLES W. CHIDSEY III, M.D., A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES W. CHIDSEY III M.D. (PRESIDENT)
(818) 363-9732
Entity
Organization
Contact information
Practice address
17075 DEVONSHIRE ST, SUITE 106, NORTHRIDGE, CA 91325-5405
(818) 363-9732
(818) 363-9853
Mailing address
17075 DEVONSHIRE ST, SUITE 106, NORTHRIDGE, CA 91325-5405
(818) 363-9732
(818) 363-9853
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G465240
BLUE SHIELD
CA
05
—
00G465240
—
CA
01
—
G46524
BLUE CROSS
CA
Enumeration date
11/20/2007
Last updated
06/20/2012
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