Healthcare Provider Details

I. General information

NPI: 1104211077
Provider Name (Legal Business Name): KATHERINE CHAVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 W CHESTER PIKE STE 340
NEWTOWN SQUARE PA
19073-2304
US

IV. Provider business mailing address

3855 W CHESTER PIKE STE 340
NEWTOWN SQUARE PA
19073-2304
US

V. Phone/Fax

Practice location:
  • Phone: 484-227-9680
  • Fax: 484-227-9695
Mailing address:
  • Phone: 484-227-9680
  • Fax: 484-227-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number59969
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD480522
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: