Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 01034016 | IN |
N | 207YS0123X | Facial Plastic Surgeon | 23772 | KY |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 01034016 | IN |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 23772 | KY |
NPI | 1629134739 |
---|---|
Provider Name | Donn Randolph Chatham |
First Address | New Albany, IN 47150-4929 |
Second Address | New Albany, IN 47150-4929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2006 |
Last Update Date | 17/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000323054 | ANTHEM PIN # (01) | |
100116140A | (05) | IN |
1336238591 | NPI CHATHAM FACIAL PLASTI (01) | |
C75291 | (02) | |
DB7559 | RAILROAD MEDICARE GROUP (01) | IN |
DC6172 | RAILROAD MEDICARE GROUP (01) | KY |
P00125999 | RAILROAD MEDICARE PIN (01) | IN |
P00180026 | RAILROAD MEDICARE PIN (01) | KY |