Healthcare Provider Details

I. General information

NPI: 1184615163
Provider Name (Legal Business Name): CHAD CHITESTER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SHERMAN ST STE 2500
JAMESTOWN NY
14701-7082
US

IV. Provider business mailing address

95 E CHAUTAUQUA ST PO BOX 168
MAYVILLE NY
14757-0168
US

V. Phone/Fax

Practice location:
  • Phone: 716-338-9797
  • Fax:
Mailing address:
  • Phone: 716-753-7107
  • Fax: 716-753-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number007155
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: