Provider Demographics
NPI:1063458826
Name:CHICOLA, CATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:
Last Name:CHICOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440
Mailing Address - Country:US
Mailing Address - Phone:541-687-7134
Mailing Address - Fax:541-687-7135
Practice Address - Street 1:1255 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-687-7134
Practice Address - Fax:541-687-7135
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD220382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134159Medicaid
AKMD883ORMedicaid
WA8296766Medicaid
OR8004138-01OtherREGENCE
AKMD8831RMedicaid
OR8005089-30OtherREGENCE
OR134159Medicaid
OR104261Medicare PIN
AKMD8831RMedicaid
OR104262Medicare PIN
E84361Medicare UPIN
WA8296766Medicaid
OR300100481Medicare PIN
OR300100480Medicare PIN