Provider Demographics
NPI:1508871898
Name:CHIDPUNGTAM, DANIEL A (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:CHIDPUNGTAM
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 1:1 SOUTH PROSPECT STREET
Mailing Address - Street 2:UHC CAMPUS 6TH FLOOR PSYCHIATRY
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5505
Mailing Address - Country:US
Mailing Address - Phone:802-847-4560
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTH PROSPECT STREET
Practice Address - Street 2:UHC CAMPUS 6TH FLOOR PSYCHIATRY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5505
Practice Address - Country:US
Practice Address - Phone:802-847-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00122862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I27144Medicare UPIN