Provider Demographics
NPI:1497752695
Name:CHATLOS, JOHN CALVIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CALVIN
Last Name:CHATLOS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:CALVIN
Other - Last Name:CHATLOS LLC
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:973 HOLMDEL RD
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2124
Mailing Address - Country:US
Mailing Address - Phone:732-834-0368
Mailing Address - Fax:732-834-9891
Practice Address - Street 1:973 HOLMDEL RD
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2124
Practice Address - Country:US
Practice Address - Phone:732-834-0368
Practice Address - Fax:732-834-9891
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA462622084P0800X
NJMA 462622084P0802X, 2084P0804X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ372324OtherMEDICARE PTAN
NJ2508206Medicaid
NJ2508206Medicaid