Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD036917L | PA |
NPI | 1295747897 |
---|---|
Provider Name | Iftikhar Ahmed Chatha |
First Address | Hermitage, PA 16148-4602 |
Second Address | Hermitage, PA 16148-4602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 27/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007033140003 | (05) | PA |
0345077 | (05) | OH |
069781 | HIGHMARK BLUE SHIELD (01) | PA |
441082339 | RAILROAD MEDICARE (01) | |
C28905 | (02) | PA |