Provider Demographics
NPI:1023039229
Name:CHET PHITAYAKORN, MD PC
Entity Type:Organization
Organization Name:CHET PHITAYAKORN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHET
Authorized Official - Middle Name:
Authorized Official - Last Name:PHITAYAKORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-469-7030
Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3730
Mailing Address - Country:US
Mailing Address - Phone:412-469-7030
Mailing Address - Fax:412-469-7160
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:SUITE 365
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-469-7030
Practice Address - Fax:412-469-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031414L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017555940001Medicaid
PAB39933Medicare UPIN
PA599410Medicare ID - Type Unspecified