1710984927 NPI number — DR. JENNIFER H CHAPMAN MD

Table of content: DR. JENNIFER H CHAPMAN MD (NPI 1710984927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710984927 NPI number — DR. JENNIFER H CHAPMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAPMAN
Provider First Name:
JENNIFER
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1710984927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751803
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28275-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-718-4820
Provider Business Mailing Address Fax Number:
704-384-7830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
865 W LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27030-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-719-6100
Provider Business Practice Location Address Fax Number:
336-719-2313
Provider Enumeration Date:
07/01/2005

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: 207Q00000X , with the licence number:  9900182 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 97378 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1984725 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 080193901 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 226578 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 126U1 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 37410 . This is a "PARTNERS MEDICARE CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89126U1 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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