Healthcare Provider Details

I. General information

NPI: 1245201151
Provider Name (Legal Business Name): PRITHVIRAJ RAJARAM CHAVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N COLLEGE ST
GREENVILLE AL
36037-2025
US

IV. Provider business mailing address

300 N COLLEGE ST
GREENVILLE AL
36037-2025
US

V. Phone/Fax

Practice location:
  • Phone: 334-382-1237
  • Fax: 334-382-1239
Mailing address:
  • Phone: 334-382-1237
  • Fax: 334-382-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01066030A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.097300
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD29830
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: