Provider Demographics
NPI:1174586051
Name:CHMURA, MARY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:CHMURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 OLD NORTH RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01098-9753
Mailing Address - Country:US
Mailing Address - Phone:413-238-5511
Mailing Address - Fax:413-238-5358
Practice Address - Street 1:58 OLD NORTH RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MA
Practice Address - Zip Code:01098-9753
Practice Address - Country:US
Practice Address - Phone:413-238-5511
Practice Address - Fax:413-238-5358
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20-2253144OtherPLAN VISTA
MA20-2253144OtherUNICARE/GIC
MA36365OtherHEALTH NEW ENGLAND
MA87333OtherCHILDREN'S MED. SECURITY
MAJ28908OtherBCBS MA
MA000000031433OtherBMC
MA414540OtherTUFTS
MA20-2253144OtherNORTH AMERICAN PREFERRED
MA3840924OtherAETNA
MAAA34373OtherHARVARD PILGRIM
MA221958OtherCONNECTICARE
MA4470530OtherCIGNA
MA20-2253144OtherNORTHEAST HEALTH DIRECT
MA2104784Medicaid
MA20-2253144OtherCONSOLIDATED
MA20-2253144OtherGREAT-WEST
MA20-2253144OtherPHCS
MA22-2253144OtherNORTHEAST HEALTHCARE ALLI
MA20-2253144OtherCONSOLIDATED
MA3840924OtherAETNA