Provider Demographics
NPI:1184644650
Name:PHILIP L CHATHAM MD INC
Entity Type:Organization
Organization Name:PHILIP L CHATHAM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-366-1878
Mailing Address - Street 1:16801 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-7405
Mailing Address - Country:US
Mailing Address - Phone:818-366-1878
Mailing Address - Fax:818-360-7850
Practice Address - Street 1:16801 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7405
Practice Address - Country:US
Practice Address - Phone:818-366-1878
Practice Address - Fax:818-360-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32433207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32433OtherBLUE CROSS
CA00A324330OtherBLUESHIELD
CA760111577OtherRAILROAD
CAGR0088970Medicaid
CAW15096AMedicare ID - Type Unspecified
CA00A324330OtherBLUESHIELD
CAA32433OtherBLUE CROSS
CA760111577OtherRAILROAD