Provider Demographics
NPI:1629134739
Name:CHATHAM, DONN RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:DONN
Middle Name:RANDOLPH
Last Name:CHATHAM
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 1:1919 STATE ST
Mailing Address - Street 2:SUITE 144
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4929
Mailing Address - Country:US
Mailing Address - Phone:812-945-3223
Mailing Address - Fax:
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 144
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-945-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034016207YS0123X, 207YX0007X
KY23772207YS0123X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDB7559OtherRAILROAD MEDICARE GROUP
1336238591OtherNPI CHATHAM FACIAL PLASTI
KYDC6172OtherRAILROAD MEDICARE GROUP
INP00125999OtherRAILROAD MEDICARE PIN
KYP00180026OtherRAILROAD MEDICARE PIN
000000323054OtherANTHEM PIN #
IN100116140AMedicaid
IN100116140AMedicaid
IN216610AMedicare PIN
INP00125999OtherRAILROAD MEDICARE PIN
IN216610Medicare PIN
000000323054OtherANTHEM PIN #