# PEDIATRIC AND ADOLESCENT HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619923752
- **Authorized official:** J ROGER CHATTERTON MD (PHYSICIAN)
- **Authorized official phone:** (607) 770-1988

## Contact information

- **Practice address:** 639 MAIN ST, JOHNSON CITY, NY 13790-1805
- **Practice address phone:** (607) 770-1988
- **Mailing address:** 639 MAIN ST, JOHNSON CITY, NY 13790-1805
- **Mailing address phone:** (607) 770-1988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 08/22/2020