Provider Demographics
NPI:1326237140
Name:JEFFREY A. CHAITOFF,MD,LLC
Entity Type:Organization
Organization Name:JEFFREY A. CHAITOFF,MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-919-0180
Mailing Address - Street 1:6563 WILSON MILLS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44143-6401
Mailing Address - Country:US
Mailing Address - Phone:440-919-0180
Mailing Address - Fax:440-919-0181
Practice Address - Street 1:6563 WILSON MILLS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-6401
Practice Address - Country:US
Practice Address - Phone:440-919-0180
Practice Address - Fax:440-919-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036076C261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2834366Medicaid
OH9371431Medicare PIN
DG4462Medicare PIN