Provider Demographics
NPI:1003851148
Name:CHAHIN, LOURDES J (MD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:J
Last Name:CHAHIN
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 1:7789 NW BEACON SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1326
Mailing Address - Country:US
Mailing Address - Phone:561-241-7977
Mailing Address - Fax:561-981-5355
Practice Address - Street 1:7789 NW BEACON SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1326
Practice Address - Country:US
Practice Address - Phone:561-241-7977
Practice Address - Fax:561-981-5355
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1013692084P0800X
GA0571542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA900480495AMedicaid
GA900480495BMedicaid