Provider Demographics
NPI:1023064060
Name:CHATHAM, PEGGY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ELIZABETH
Last Name:CHATHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 CONGO CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5820
Mailing Address - Country:US
Mailing Address - Phone:239-464-7542
Mailing Address - Fax:239-540-0975
Practice Address - Street 1:12734 KENWOOD LN
Practice Address - Street 2:STE. 84
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5666
Practice Address - Country:US
Practice Address - Phone:239-936-5250
Practice Address - Fax:239-936-9970
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME912162084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16047Medicare ID - Type Unspecified
FLF31423Medicare UPIN