Provider Demographics
NPI:1295747897
Name:CHATHA, IFTIKHAR AHMED (MD)
Entity type:Individual
Prefix:
First Name:IFTIKHAR
Middle Name:AHMED
Last Name:CHATHA
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 1:2500 HIGHLAND RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4602
Mailing Address - Country:US
Mailing Address - Phone:724-981-7003
Mailing Address - Fax:724-981-2171
Practice Address - Street 1:2500 HIGHLAND RD STE 102
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4602
Practice Address - Country:US
Practice Address - Phone:724-981-7003
Practice Address - Fax:724-981-2171
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036917L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA069781OtherHIGHMARK BLUE SHIELD
PA0007033140003Medicaid
OH0345077Medicaid
441082339OtherRAILROAD MEDICARE
OH0345077Medicaid
OH4060631Medicare PIN
PAC28905Medicare UPIN
PA069781Medicare ID - Type Unspecified