=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285785600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IFTIKHAR A. CHATHA, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2007
-----------------------------------------------------
Last Update Date | 01/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 HIGHLAND RD SUITE 102
-----------------------------------------------------
City | HERMITAGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16148-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-981-7003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 HIGHLAND RD SUITE 102
-----------------------------------------------------
City | HERMITAGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16148-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-981-7003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | IFTIKHAR A. CHATHA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 724-981-7003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | MD036917L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------