Provider Demographics
NPI:1922085554
Name:CHATHAM, SCOTT T (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:CHATHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:1501 TATE BLVD SE
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-0038
Mailing Address - Country:US
Mailing Address - Phone:828-322-4140
Mailing Address - Fax:828-322-3767
Practice Address - Street 1:1501 TATE BLVD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4243
Practice Address - Country:US
Practice Address - Phone:828-322-4140
Practice Address - Fax:828-322-3767
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC21921207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922069Medicaid
C83200Medicare UPIN
NC8922069Medicaid