Provider Demographics
NPI:1053541581
Name:THARPE, CHET JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHET
Middle Name:
Last Name:THARPE
Suffix:JR
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 1:504 N MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-2804
Mailing Address - Country:US
Mailing Address - Phone:601-559-6188
Mailing Address - Fax:
Practice Address - Street 1:320 LINCOLN BLVD #100
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-9029
Practice Address - Country:US
Practice Address - Phone:310-697-8126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122884207KA0200X, 207R00000X
WI67006-20207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03185790Medicaid
MS03185790Medicaid