Provider Demographics
NPI:1639874761
Name:CHAMBERLIN, RICHARD CHAZ (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHAZ
Last Name:CHAMBERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R.
Other - Middle Name:CHAZ
Other - Last Name:CHAMBERLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1430 TULANE AVE # XXXX
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-7808
Mailing Address - Fax:504-988-7808
Practice Address - Street 1:1430 TULANE AVE # XXXX
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2632
Practice Address - Country:US
Practice Address - Phone:504-988-7808
Practice Address - Fax:504-988-7808
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program