Provider Demographics
NPI:1245201151
Name:CHAVAN, PRITHVIRAJ RAJARAM (MD)
Entity Type:Individual
Prefix:
First Name:PRITHVIRAJ
Middle Name:RAJARAM
Last Name:CHAVAN
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 1:300 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-2025
Mailing Address - Country:US
Mailing Address - Phone:334-382-1237
Mailing Address - Fax:334-382-1239
Practice Address - Street 1:300 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-2025
Practice Address - Country:US
Practice Address - Phone:334-382-1237
Practice Address - Fax:334-382-1239
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066030A207X00000X
OH35.097300207X00000X
ALMD29830207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-15632OtherBLUECROSS/BLUESHIELD
AL6461214OtherCIGNA
1871003533OtherGROUP NPI
AL129162Medicaid
AL6461214OtherCIGNA
AL102I208405Medicare PIN