MEDICARE: REBECCA P CHATHAM MD

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	207Q00000X	Family Medicine Physician	40231	KY

General Provider Information

NPI Number	:	1982819728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA P CHATHAM MD

Provider Business Mailing Address
First Line	:	PO BOX 1213
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40423-1213
Country	:	US
Telephone Number	:	859-236-2425
Fax Number	:	859-236-2292

Provider Business Practice Location Address
First Line	:	120 ENTERPRISE DR
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40422-1870
Country	:	US
Telephone Number	:	859-236-2425
Fax Number	:	859-236-9776

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	05/10/2017

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