Healthcare Provider Details

I. General information

NPI: 1952328833
Provider Name (Legal Business Name): FREEMAN M CHAKARA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W MAIN ST
LEOLA PA
17540-1753
US

IV. Provider business mailing address

2003 OLD ROTHSVILLE RD
LITITZ PA
17543-9133
US

V. Phone/Fax

Practice location:
  • Phone: 717-556-0149
  • Fax: 717-556-0149
Mailing address:
  • Phone: 717-556-0149
  • Fax: 717-556-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS009409
License Number StatePA

VIII. Authorized Official

Name: FREEMAN M CHAKARA
Title or Position: OWNER
Credential: PSYD
Phone: 717-556-0149