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General NPI Number Information
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NPI Number | 1497940977
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Entity Type | Organization
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Legal Business Name | MARISHA CHILCOTT MD INC
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 1144 SONOMA AVE STE 104
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City | SANTA ROSA
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State | CA
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Zip | 95405-4812
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Country | US
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Telephone | 707-542-1933
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Fax | 707-542-6227
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Provider Business Mailing Address
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Address Line | 1144 SONOMA AVE STE 104
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City | SANTA ROSA
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State | CA
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Zip | 95405-4812
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Country | US
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Telephone | 707-542-1933
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Fax | 707-542-6227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARISHA CHILCOTT
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Credential | M.D.
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Telephone | 707-542-1933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A88901
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License Number State | CA
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