Healthcare Provider Details

I. General information

NPI: 1629134739
Provider Name (Legal Business Name): DONN RANDOLPH CHATHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 STATE ST SUITE 144
NEW ALBANY IN
47150-4929
US

IV. Provider business mailing address

1919 STATE ST SUITE 144
NEW ALBANY IN
47150-4929
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-3223
  • Fax:
Mailing address:
  • Phone: 812-945-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number01034016
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number01034016
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number23772
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number23772
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: