DR. AMBROSE JOHN JOSEPH CHAZHIKATTU, MD - NPI NUMBER 1629206701

Summary

Provider Name: DR. AMBROSE JOHN JOSEPH CHAZHIKATTU, MD

NPI Number: 1629206701

Clasification: Student in an Organized Health Care Education/Training Program (390200000X)

Organization: J. ARTHUR DOSHER MEMORIAL HOSPITAL

Address:
924 N. HOWE ST.
SOUTHPORT, NC
ZIP 28461

Phone Number: (910) 457-3910



Detailed Information

DR. Ambrose John Joseph Chazhikattu, MD is a student in an organized health care education/training program in Southport, NC with 7 years of experience. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. The assigned NPI number for this provider is 1629206701 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

924 N. HOWE ST.
SOUTHPORT, NC
ZIP 28461
Phone: (910) 457-3910
Fax: (910) 457-3931

The enumeration date for this NPI number is 6/26/2009 and was last updated on 6/30/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 390200000X Student in an Organized Health Care Education/Training Program Yes

NPI Record

No. Field Name Field Value
1 NPI 1629206701
2 Entity Type Code 1
3 Provider Last Name Legal Name CHAZHIKATTU
4 Provider First Name AMBROSE JOHN
5 Provider Middle Name JOSEPH
6 Provider Name Prefix Text DR.
7 Provider Credential Text MD
8 Provider First Line Business Practice Location Address 924 N. HOWE ST.
9 Provider Business Practice Location Address City Name SOUTHPORT
10 Provider Business Practice Location Address State Name NC
11 Provider Business Practice Location Address Postal Code 28461
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 9104573910
14 Provider Business Practice Location Address Fax Number 9104573931
15 Provider Enumeration Date 6/26/2009
16 Last Update Date 6/30/2014
17 Provider Gender Code M
18 Healthcare Provider Taxonomy Code 1 390200000X
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Is Sole Proprietor N

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This page was last updated on: 12/10/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.