Provider Demographics
NPI:1619018900
Name:CHIAVACCI ORTHOPEDICS, PC
Entity type:Organization
Organization Name:CHIAVACCI ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHIAVACCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-457-3300
Mailing Address - Street 1:730 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1459
Mailing Address - Country:US
Mailing Address - Phone:570-457-3300
Mailing Address - Fax:570-457-4878
Practice Address - Street 1:730 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1459
Practice Address - Country:US
Practice Address - Phone:570-457-3300
Practice Address - Fax:570-457-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027185E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009209150004Medicaid
PA0009209150004Medicaid
PACH433101Medicare ID - Type Unspecified