Provider Demographics
NPI:1003180993
Name:CHAMPLAIN, AMANDA HOPE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:HOPE
Last Name:CHAMPLAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 ELDORADO PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-0289
Mailing Address - Country:US
Mailing Address - Phone:972-335-2727
Mailing Address - Fax:
Practice Address - Street 1:4685 ELDORADO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-0289
Practice Address - Country:US
Practice Address - Phone:972-335-2727
Practice Address - Fax:972-668-8444
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1782207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA113823OtherSID # 113823