Individual
DR. WALTER RANDOLPH CHITWOOD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
115 HEART DR DEPT OF, EAST CAROLINA HEART INSTITUTE @ ECU DEPT. OF CVS, GREENVILLE, NC 27834-8944
(252) 744-4400
(252) 744-3987
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
(252) 744-3520
(252) 744-3194
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
27140
NC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
27140
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22370
BCBS NC
NC
01
—
330004174
RAILROAD MEDICARE
NC
05
—
8922370
—
NC
Enumeration date
07/12/2005
Last updated
11/02/2011
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