Provider Demographics
NPI:1235373093
Name:CHAMBERLAIN, RYAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOSEPH
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 TULANE AVE RM 459
Mailing Address - Street 2:BOX T4 M2F
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-903-3594
Mailing Address - Fax:
Practice Address - Street 1:1542 TULANE AVE RM 459
Practice Address - Street 2:BOX T4 M2F
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2865
Practice Address - Country:US
Practice Address - Phone:504-903-3594
Practice Address - Fax:504-903-4569
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204063207P00000X
MS22510207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1883212Medicaid