Provider Demographics
NPI:1740865880
Name:CHATMAN, CRAIG LAMARR
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:LAMARR
Last Name:CHATMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2533
Mailing Address - Country:US
Mailing Address - Phone:716-381-6091
Mailing Address - Fax:
Practice Address - Street 1:327 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2533
Practice Address - Country:US
Practice Address - Phone:716-713-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY882150685172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12121963Medicaid