1366868879 NPI number — JEFFREY R. CHAMBERS, MD, PA

Table of content: (NPI 1366868879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366868879 NPI number — JEFFREY R. CHAMBERS, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY R. CHAMBERS, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1366868879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4016 BARRETT DR
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-6623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-490-9787
Provider Business Mailing Address Fax Number:
888-379-3488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3308 DURHAM CHAPEL HILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 131
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-2694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-490-9787
Provider Business Practice Location Address Fax Number:
888-379-3488
Provider Enumeration Date:
03/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TARKER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
919-623-4619

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  31786 , 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: 8921899 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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