Provider Demographics
NPI:1295815959
Name:COLLEGE PARK MEDICINE,PA
Entity Type:Organization
Organization Name:COLLEGE PARK MEDICINE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-271-2555
Mailing Address - Street 1:17191 ST LUKES WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8043
Mailing Address - Country:US
Mailing Address - Phone:936-271-2555
Mailing Address - Fax:936-271-2557
Practice Address - Street 1:17191 ST LUKES WAY STE 200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8043
Practice Address - Country:US
Practice Address - Phone:936-271-2555
Practice Address - Fax:936-271-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00648YMedicare PIN