Provider Demographics
NPI:1588073589
Name:CHABUT, CAITLIN (PA)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CHABUT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7677 YANKEE ST STE 140
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3475
Mailing Address - Country:US
Mailing Address - Phone:937-454-9527
Mailing Address - Fax:937-454-9532
Practice Address - Street 1:7677 YANKEE ST STE 140
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3475
Practice Address - Country:US
Practice Address - Phone:937-454-9527
Practice Address - Fax:937-454-9532
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108307Medicaid
OHH356380Medicare PIN