Provider Demographics
NPI:1174600985
Name:CHILCOTT, MARISHA E (MD)
Entity type:Individual
Prefix:DR
First Name:MARISHA
Middle Name:E
Last Name:CHILCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARISHA
Other - Middle Name:ERIKA
Other - Last Name:LOCKWOOD-CHILCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2800 CLEVELAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2784
Mailing Address - Country:US
Mailing Address - Phone:707-921-7447
Mailing Address - Fax:888-995-0195
Practice Address - Street 1:2800 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2783
Practice Address - Country:US
Practice Address - Phone:707-800-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI50886Medicare UPIN
CAGG404Medicare PIN