1790940997 NPI number — CHESTER Z. HAVERBACK, M.D., CHARTERED

Table of content: (NPI 1790940997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790940997 NPI number — CHESTER Z. HAVERBACK, M.D., CHARTERED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTER Z. HAVERBACK, M.D., CHARTERED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790940997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8218 WISCONSIN AVENUE
Provider Second Line Business Mailing Address:
#320
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-657-4747
Provider Business Mailing Address Fax Number:
301-657-9065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8218 WISCONSIN AVENUE
Provider Second Line Business Practice Location Address:
#320
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-657-4747
Provider Business Practice Location Address Fax Number:
301-657-9065
Provider Enumeration Date:
07/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAVERBACK, M.D.
Authorized Official First Name:
CHESTER
Authorized Official Middle Name:
Z.
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
301-657-4747

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  MD25318 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: D05089 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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