Provider Demographics
NPI:1437128295
Name:CHANTILES, FRED DON (DPM)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:DON
Last Name:CHANTILES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-1255
Mailing Address - Country:US
Mailing Address - Phone:717-843-0896
Mailing Address - Fax:717-854-6519
Practice Address - Street 1:1546 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-1255
Practice Address - Country:US
Practice Address - Phone:717-843-0896
Practice Address - Fax:717-854-6519
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001504L213ES0103X, 213ES0131X, 213ER0200X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000503609Medicaid
PA124432M3JMedicare PIN
T29294Medicare UPIN