Provider Demographics
NPI:1386668432
Name:CHAMBERLAIN, JUDITH (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:CHAMBERLAIN
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 1:174 S FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6145
Mailing Address - Country:US
Mailing Address - Phone:207-865-1819
Mailing Address - Fax:207-865-4535
Practice Address - Street 1:74 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3218
Practice Address - Country:US
Practice Address - Phone:207-798-4050
Practice Address - Fax:207-798-4018
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME026424OtherANTHEM
ME1386668432OtherTRICARE
ME4636282OtherAETNA
MED03590OtherHARVARD PILGRIM
ME1386668432OtherTRICARE
ME4636282OtherAETNA