Basic Information
| Provider Information | |||||||||
| NPI: | 1184615163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHITESTER | ||||||||
| FirstName: | CHAD | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 E CHAUTAUQUA ST | ||||||||
| Address2: | PO BOX 168 | ||||||||
| City: | MAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147570168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167537107 | ||||||||
| FaxNumber: | 7167535367 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 PRATHER AVENUE SUITE 100 & SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147012514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163380022 | ||||||||
| FaxNumber: | 7167535367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 03/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 007155 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | J400003830 | 01 | NY | MEDICARE | OTHER | 02342092 | 05 | NY | MEDICAID |