Healthcare Provider Details

I. General information

NPI: 1326481540
Provider Name (Legal Business Name): SAM CHATTERTON-KIRCHMEIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HARBOUR WAY S
RICHMOND CA
94804-2426
US

IV. Provider business mailing address

150 HARBOUR WAY S
RICHMOND CA
94804-2426
US

V. Phone/Fax

Practice location:
  • Phone: 206-724-8462
  • Fax:
Mailing address:
  • Phone: 206-724-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA132095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: