Provider Demographics
NPI:1285785600
Name:IFTIKHAR A. CHATHA, MD, PC
Entity type:Organization
Organization Name:IFTIKHAR A. CHATHA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IFTIKHAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHATHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-981-7003
Mailing Address - Street 1:2500 HIGHLAND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4602
Mailing Address - Country:US
Mailing Address - Phone:724-981-7003
Mailing Address - Fax:
Practice Address - Street 1:2500 HIGHLAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4602
Practice Address - Country:US
Practice Address - Phone:724-981-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036917L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
441082339OtherRAILROAD MEDICARE
OH0345077Medicaid
PA0007033140003Medicaid
PA0007033140003Medicaid
OH0345077Medicaid