1386615037 NPI number — JEFFREY P CHAPDELAINE MD

Table of content: JEFFREY P CHAPDELAINE MD (NPI 1386615037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386615037 NPI number — JEFFREY P CHAPDELAINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAPDELAINE
Provider First Name:
JEFFREY
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1386615037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1849
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04241-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-784-2554
Provider Business Mailing Address Fax Number:
207-777-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 KINSLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-882-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2006

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: 2085R0202X , with the licence number:  9983 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , with the licence number: 9983 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 80004481 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300082131 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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