Provider Demographics
NPI:1144535402
Name:CHATTHA, MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:CHATTHA
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 1:19 BLOSSOM ROW
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2509
Mailing Address - Country:US
Mailing Address - Phone:718-532-6585
Mailing Address - Fax:
Practice Address - Street 1:1130 LINDEN ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2144
Practice Address - Country:US
Practice Address - Phone:516-320-8156
Practice Address - Fax:317-953-7253
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT197032390200000X
NY284872207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04563035Medicaid