Provider Demographics
NPI:1295016350
Name:RASTATTER, CHADWICK TOWNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:TOWNE
Last Name:RASTATTER
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 1:5511 S CONGRESS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1140
Mailing Address - Country:US
Mailing Address - Phone:561-964-1632
Mailing Address - Fax:561-964-1636
Practice Address - Street 1:5511 S CONGRESS AVE STE 105
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1140
Practice Address - Country:US
Practice Address - Phone:561-964-1632
Practice Address - Fax:561-964-1636
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128084208600000X
FLTRN16783390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021033400Medicaid