Provider Demographics
NPI:1053305722
Name:CHAMBERLAIN, MATTHEW P (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:91 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9590
Practice Address - Country:US
Practice Address - Phone:252-451-3200
Practice Address - Fax:252-937-3107
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC35293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5711074OtherCIGNA HEALTHCARE
NC8921939Medicaid
NC61344OtherMEDCOST
NC110095560OtherRAILROAD MEDICARE
NC21939OtherBCBSNC
NC61344OtherMEDCOST
NC8921939Medicaid