Provider Demographics
NPI:1134187107
Name:CHILLCOTT, JAMES HT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HT
Last Name:CHILLCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4985
Mailing Address - Country:US
Mailing Address - Phone:440-992-4422
Mailing Address - Fax:440-997-6507
Practice Address - Street 1:6441 S MAIN ST
Practice Address - Street 2:
Practice Address - City:N KINGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44048
Practice Address - Country:US
Practice Address - Phone:440-224-2255
Practice Address - Fax:440-997-6507
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08959338Medicaid
OHCH07292581Medicare ID - Type Unspecified
OH08959338Medicaid