MEDICARE: MARIA PLANTHARA CHATHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ME54761	FL

General Provider Information

NPI Number	:	1780080028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA PLANTHARA CHATHAM M.D.

Provider Business Mailing Address
First Line	:	7400 SUN ISLAND DR S APT 501
Second Line	:
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-4419
Country	:	US
Telephone Number	:	727-543-7797
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 SUN ISLAND DR S APT 501
Second Line	:
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-4419
Country	:	US
Telephone Number	:	727-543-7797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	11/14/2014

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