Provider Demographics
NPI:1770782195
Name:CHADAKOFF, CHARLES ANDREW (PA-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:CHADAKOFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7326 LARAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3097
Mailing Address - Country:US
Mailing Address - Phone:702-787-4867
Mailing Address - Fax:702-614-9928
Practice Address - Street 1:5380 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1877
Practice Address - Country:US
Practice Address - Phone:702-845-2841
Practice Address - Fax:702-252-4405
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1050363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512583Medicaid
NVP00427707Medicare PIN