Provider Demographics
NPI:1508869892
Name:CHAPMAN, CATHY M (MD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:M
Last Name:CHAPMAN
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 1:2118 KIRBY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5510
Mailing Address - Country:US
Mailing Address - Phone:901-757-9730
Mailing Address - Fax:
Practice Address - Street 1:5210 POPLAR AVE
Practice Address - Street 2:STE 150
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3507
Practice Address - Country:US
Practice Address - Phone:901-757-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0024040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN164844OtherBCBS PROVIDER NUMBER
TN44D0869618OtherCLIA NUMBER
TN3073678Medicaid
TN0339703001OtherCIGNA PROVIDER NUMBER
TN3073678Medicaid
TN3073678Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER