Provider Demographics
NPI:1104916691
Name:CHATHAM, MARIE D (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:D
Last Name:CHATHAM
Suffix:
Gender:F
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:PO BOX 418953
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 203
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:443-849-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020907207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4800004OtherUNITEDHEALTHCARE MCO
90530OtherUNITEDHEALTHCARE
290010122OtherRAILROAD MEDICARE
542085OtherMAMSI
MD30645001 420AOtherBLUE SHIELD
MD0007 E554OtherBLUE CHOICE
MD712L/218191YBPGMedicare PIN
MD30645001 420AOtherBLUE SHIELD
90530OtherUNITEDHEALTHCARE