Provider Demographics
NPI:1346480563
Name:CHITTUM, CHARLES HENRY (CONTRACTOR)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HENRY
Last Name:CHITTUM
Suffix:
Gender:M
Credentials:CONTRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 JOHN CLAYTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-5323
Mailing Address - Country:US
Mailing Address - Phone:804-693-0794
Mailing Address - Fax:
Practice Address - Street 1:8910 JOHN CLAYTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-5323
Practice Address - Country:US
Practice Address - Phone:804-693-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705 052385171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications