MEDICARE: CHET PHITAYAKORN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD031414L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922003094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHET PHITAYAKORN M.D.

Provider Business Mailing Address
First Line	:	575 COAL VALLEY RD
Second Line	:	STE 365
City	:	CLAIRTON
State	:	PA
Zip	:	15025-3739
Country	:	US
Telephone Number	:	412-469-7030
Fax Number	:	412-469-7160

Provider Business Practice Location Address
First Line	:	575 COAL VALLEY RD
Second Line	:	STE 365
City	:	CLAIRTON
State	:	PA
Zip	:	15025-3739
Country	:	US
Telephone Number	:	412-469-7030
Fax Number	:	412-469-7160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/08/2014

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