Provider Demographics
NPI:1578515029
Name:DE CHADAREVIAN, JEAN-PIERRE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-PIERRE
Middle Name:
Last Name:DE CHADAREVIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MONTGOMERY AVE
Mailing Address - Street 2:B1
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2845
Mailing Address - Country:US
Mailing Address - Phone:610-664-9769
Mailing Address - Fax:
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:ST CHRISTOPHER'S HOSPITAL FOR CHILDREN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-5272
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035177E207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011409280010Medicaid
PAE64435Medicare UPIN
PA534263Medicare ID - Type Unspecified