Individual
ROY D CHISHOLM III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12502 WILLOWBROOK RD, SUITE 500, CUMBERLAND, MD 21502-6491
(301) 724-8847
(301) 724-7016
Mailing address
12502 WILLOWBROOK RD, SUITE 500, CUMBERLAND, MD 21502-6491
(301) 724-8847
(301) 724-7016
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
D34362
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0126225000
WV MEDICAID
WV
01
—
1344505
UNITED HEALTHCARE
MD
01
—
2530906005
CIGNA
MD
01
—
424535
CAREFIRST BLUE SHIELD
MD
01
—
425241
MAMSI
MD
05
—
531441100
—
MD
Enumeration date
07/16/2006
Last updated
03/13/2024
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