1184644650 NPI number — PHILIP L CHATHAM MD INC

Table of content: (NPI 1184644650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184644650 NPI number — PHILIP L CHATHAM MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP L CHATHAM MD INC
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:
1184644650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16801 DEVONSHIRE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANADA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91344-7405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-366-1878
Provider Business Mailing Address Fax Number:
818-360-7850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16801 DEVONSHIRE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANADA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91344-7405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-366-1878
Provider Business Practice Location Address Fax Number:
818-360-7850
Provider Enumeration Date:
07/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHATHAM
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICIAN/PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
818-366-1878

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  A32433 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A32433 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A324330 . This is a "BLUESHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 760111577 . This is a "RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0088970 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".