Provider Demographics
NPI:1952328833
Name:FREEMAN M CHAKARA PC
Entity Type:Organization
Organization Name:FREEMAN M CHAKARA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREEMAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAKARA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:717-556-0149
Mailing Address - Street 1:2003 OLD ROTHSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9133
Mailing Address - Country:US
Mailing Address - Phone:717-556-0149
Mailing Address - Fax:717-556-0149
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1753
Practice Address - Country:US
Practice Address - Phone:717-556-0149
Practice Address - Fax:717-556-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009409103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001334567OtherHIGHMARK BLUE SHIELD
PA001897858Medicaid
PA02271001OtherCAPITAL BLUE CROSS
PA1548467OtherGATEWAY MEDICARE ASSURED
PA680015251OtherRAILROAD MEDICARE
PA1548467OtherGATEWAY MEDICARE ASSURED
PAP56460Medicare UPIN