Provider Demographics
NPI:1255500583
Name:RICHARD L CHAMBERLAIN DO LLC
Entity Type:Organization
Organization Name:RICHARD L CHAMBERLAIN DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-746-8357
Mailing Address - Street 1:909 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1700
Mailing Address - Country:US
Mailing Address - Phone:937-746-8357
Mailing Address - Fax:937-746-1992
Practice Address - Street 1:909 E 2ND ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1700
Practice Address - Country:US
Practice Address - Phone:937-746-8357
Practice Address - Fax:937-746-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH34-00-4313C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0701306Medicaid
RI9349221Medicare PIN
OHF12470Medicare UPIN