Provider Demographics
NPI:1437263993
Name:CHAMBERLAIN, DERMOT PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:DERMOT
Middle Name:PETER
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 191ST PL SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9709
Mailing Address - Country:US
Mailing Address - Phone:425-641-1716
Mailing Address - Fax:425-641-5661
Practice Address - Street 1:14701 179TH AVE SE
Practice Address - Street 2:VALLEY GENERAL HOSPITAL
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1108
Practice Address - Country:US
Practice Address - Phone:360-794-1429
Practice Address - Fax:360-863-4650
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016443174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1025790Medicaid
WAGAB32843Medicare PIN
WA1025790Medicaid