Healthcare Provider Details

I. General information

NPI: 1982819728
Provider Name (Legal Business Name): REBECCA P CHATHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ENTERPRISE DR
DANVILLE KY
40422-1870
US

IV. Provider business mailing address

PO BOX 1213
DANVILLE KY
40423-1213
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-2425
  • Fax: 859-236-9776
Mailing address:
  • Phone: 859-236-2425
  • Fax: 859-236-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40231
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: