Provider Demographics
NPI:1770597171
Name:CHATTIN, RONALD D (DO)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:CHATTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GREAT TEAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9816
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-201-5019
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130
Practice Address - Country:US
Practice Address - Phone:304-369-0393
Practice Address - Fax:304-369-0371
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7027055OtherAETNA
WVP00369960OtherRR MEDICARE
WV001721604OtherMS BCBS
WV0050947000Medicaid
2030642Medicare PIN
WV7027055OtherAETNA
WVWV1295BMedicare PIN
2030645Medicare PIN
WVWV1295AMedicare PIN
2030644Medicare PIN
WVP00369960OtherRR MEDICARE
2030641Medicare PIN
WV001721604OtherMS BCBS
2030647Medicare PIN