1003976614 NPI number — KATHLEEN A CHAPMAN PHD

Table of content: KATHLEEN A CHAPMAN PHD (NPI 1003976614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003976614 NPI number — KATHLEEN A CHAPMAN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAPMAN
Provider First Name:
KATHLEEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003976614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1361
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASTONBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06033-6361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-233-6228
Provider Business Mailing Address Fax Number:
212-937-3110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-4240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-233-6228
Provider Business Practice Location Address Fax Number:
212-937-3110
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  002169 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 680001537 . This is a "MEDICARE PRIVATE PRACTICE" identifier . This identifiers is of the category "OTHER".




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