Provider Demographics
NPI:1851462030
Name:CHAMBERSBURG MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:CHAMBERSBURG MEDICAL ASSOCIATES
Other - Org Name:CHAMBERSBURG MEDICAL ASSOCIATE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMATUL
Authorized Official - Middle Name:BASIT
Authorized Official - Last Name:KHALID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-496-0359
Mailing Address - Street 1:1988 SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1450
Mailing Address - Country:US
Mailing Address - Phone:717-496-0359
Mailing Address - Fax:717-262-4983
Practice Address - Street 1:1988 SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1450
Practice Address - Country:US
Practice Address - Phone:717-496-0359
Practice Address - Fax:717-262-4983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAMBERSBURG MEDICAL ASSOCIATE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-10
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3680549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
106549Medicare PIN