Provider Demographics
NPI:1851520431
Name:LOMOTEY, CHAYLAH J (MD)
Entity Type:Individual
Prefix:
First Name:CHAYLAH
Middle Name:J
Last Name:LOMOTEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 COLLEGE DR 1
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3580
Mailing Address - Country:US
Mailing Address - Phone:903-614-7693
Mailing Address - Fax:903-614-5343
Practice Address - Street 1:165 S 6TH ST
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-3521
Practice Address - Country:US
Practice Address - Phone:956-689-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-05
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282617401Medicaid
TX282617401Medicaid