Provider Demographics
NPI:1013235514
Name:KALATHAS, NICHOLAOS
Entity Type:Individual
Prefix:
First Name:NICHOLAOS
Middle Name:
Last Name:KALATHAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2751
Mailing Address - Country:US
Mailing Address - Phone:717-267-7169
Mailing Address - Fax:717-267-4873
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7146
Practice Address - Fax:717-267-7728
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196913207P00000X
PAMD447758207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102810325 0002Medicaid
PA30152910OtherAMERIHEALTH CARITAS PA - YH
PA788489OtherUPMC
PA102810325 0001Medicaid
PA1622617OtherGATEWAY
PA2879187OtherHIGHMARK BLUE SHIELD
PA102810325 0001Medicaid
PA285463G0EMedicare PIN