Provider Demographics
NPI:1487617478
Name:CHESNICK, STEVEN ROBERT (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:CHESNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:215-662-2777
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4238
Practice Address - Country:US
Practice Address - Phone:215-662-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022078E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
091435OtherHIGHMARK BLUE SHIELD
1008700OtherCIGNA
PA0006413830001Medicaid
0045523000OtherINDPENDENCE BLUE CROSS
91435OtherUNITED HEALTHCARE
4088048OtherAETNA
0045523000OtherINDPENDENCE BLUE CROSS
B35504Medicare UPIN
PA0006413830001Medicaid