Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME91872 | FL |
Y | 2084N0402X | Child Neurologist | ME91872 | FL |
NPI | 1225069511 |
---|---|
Provider Name | Marc Chamberlain |
First Address | Seattle, WA 98115-6820 |
Second Address | Seattle, WA 98109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 10/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271514700 | (05) | FL |
52302 | BLUE CROSS BLUE SHIELD (01) | FL |
A49110 | (02) | FL |