Provider Demographics
NPI:1073555983
Name:CHATTHA, ASHRAF ALI (MD)
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:ALI
Last Name:CHATTHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 BERNARDIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2039
Mailing Address - Country:US
Mailing Address - Phone:803-256-1137
Mailing Address - Fax:803-256-1138
Practice Address - Street 1:1655 BERNARDIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2039
Practice Address - Country:US
Practice Address - Phone:803-256-1137
Practice Address - Fax:803-256-1138
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21213207R00000X
AZ44359207RN0300X
SC35099207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC35099OtherSC MEDICAL LICENSE
AZ614930Medicaid
WV1841984000Medicaid
H87787Medicare UPIN
WVCH4110232Medicare PIN
WVCH4110231Medicare PIN