Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 21213 | WV |
N | 111NI0900X | Internist | 21213 | WV |
Y | 207RN0300X | Nephrologist | 35099 | SC |
N | 207RN0300X | Nephrologist | 44359 | AZ |
NPI | 1073555983 |
---|---|
Provider Name | Ashraf Ali Chattha |
First Address | Columbia, SC 29204-2039 |
Second Address | Columbia, SC 29204-2039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 06/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1841984000 | (05) | WV |
35099 | SC MEDICAL LICENSE (01) | SC |
614930 | (05) | AZ |
H87787 | (02) |