Provider Demographics
NPI:1417194390
Name:CHITTUM, CHARLES STEVEN
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEVEN
Last Name:CHITTUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 FOREST SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:STUARTS DRAFT
Mailing Address - State:VA
Mailing Address - Zip Code:24477-2912
Mailing Address - Country:US
Mailing Address - Phone:540-294-5006
Mailing Address - Fax:
Practice Address - Street 1:289 FOREST SPRINGS DR
Practice Address - Street 2:
Practice Address - City:STUARTS DRAFT
Practice Address - State:VA
Practice Address - Zip Code:24477-2912
Practice Address - Country:US
Practice Address - Phone:540-294-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705032091A171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications