Provider Demographics
NPI:1265755482
Name:CHITTCHANG, AMONRATH (MD)
Entity type:Individual
Prefix:DR
First Name:AMONRATH
Middle Name:
Last Name:CHITTCHANG
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 1:9649 BELAIR RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1100
Mailing Address - Country:US
Mailing Address - Phone:410-248-2650
Mailing Address - Fax:
Practice Address - Street 1:16 GREENMEADOW DR
Practice Address - Street 2:SUITE G-105
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3200
Practice Address - Country:US
Practice Address - Phone:410-561-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B68904Medicare UPIN