Provider Demographics
NPI:1922178029
Name:CHATMAN, GERALD (PA)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:CHATMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 NOBLE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3796
Mailing Address - Country:US
Mailing Address - Phone:323-938-2300
Mailing Address - Fax:323-938-2330
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-938-2300
Practice Address - Fax:323-938-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC36136Medicare UPIN