Provider Demographics
NPI:1033191333
Name:CHAFEL, THERESA L (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:CHAFEL
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 1:200 SE HOSPITAL AVE
Mailing Address - Street 2:PATHOLOGY DEPARTMENT
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2346
Mailing Address - Country:US
Mailing Address - Phone:772-288-5853
Mailing Address - Fax:772-288-5885
Practice Address - Street 1:200 SE HOSPITAL AVE
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2346
Practice Address - Country:US
Practice Address - Phone:772-288-5853
Practice Address - Fax:772-288-5885
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71788207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257563900Medicaid
FL47185OtherBLUE CROSS BLUE SHIELD
220026709Medicare PIN
FL257563900Medicaid
FL47185OtherBLUE CROSS BLUE SHIELD