Provider Demographics
NPI:1922003094
Name:PHITAYAKORN, CHET (MD)
Entity Type:Individual
Prefix:
First Name:CHET
Middle Name:
Last Name:PHITAYAKORN
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 1:575 COAL VALLEY RD
Mailing Address - Street 2:STE 365
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3739
Mailing Address - Country:US
Mailing Address - Phone:412-469-7030
Mailing Address - Fax:412-469-7160
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:STE 365
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3739
Practice Address - Country:US
Practice Address - Phone:412-469-7030
Practice Address - Fax:412-469-7160
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031414L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006975300001Medicaid
OH0657187Medicaid
PAP01341946Medicare PIN
OH0657187Medicaid
PA166853PNLMedicare PIN