Provider Demographics
NPI:1659361780
Name:CHATHAM, TOM (PA-C)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:CHATHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-337-5894
Mailing Address - Fax:814-337-7082
Practice Address - Street 1:1015 GROVE ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2905
Practice Address - Country:US
Practice Address - Phone:814-337-5894
Practice Address - Fax:814-337-7082
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000774363AS0400X
PAMA054111363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P60646Medicare UPIN
058598Medicare ID - Type Unspecified