Provider Demographics
NPI:1245237361
Name:CHAPPELL, ANN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:L
Last Name:CHAPPELL
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 1:400 29TH ST
Mailing Address - Street 2:STE 512
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3550
Mailing Address - Country:US
Mailing Address - Phone:510-451-6959
Mailing Address - Fax:510-782-8172
Practice Address - Street 1:400 29TH ST
Practice Address - Street 2:STE 512
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3550
Practice Address - Country:US
Practice Address - Phone:510-451-6959
Practice Address - Fax:510-782-8172
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOOC3156202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA168754OtherVALUEOPTIONS
CA00C315620Medicaid
CAA34618Medicare UPIN
CA00C315620Medicaid