Provider Demographics
NPI:1275023202
Name:CHAPPELLE, KAHLIL ALI
Entity Type:Individual
Prefix:
First Name:KAHLIL
Middle Name:ALI
Last Name:CHAPPELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14314 HAMPSHIRE HALL CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2955
Mailing Address - Country:US
Mailing Address - Phone:202-470-9740
Mailing Address - Fax:
Practice Address - Street 1:2526 PENNSYLVANIA AVE SE STE C2625
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6719
Practice Address - Country:US
Practice Address - Phone:202-748-5641
Practice Address - Fax:202-748-5647
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50077951261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)