Provider Demographics
NPI:1659538668
Name:CHAMBERLIN, AMANDA M (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MEGAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:477 RT 28
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825
Mailing Address - Country:US
Mailing Address - Phone:814-849-3035
Mailing Address - Fax:814-849-4341
Practice Address - Street 1:477 RT 28
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825
Practice Address - Country:US
Practice Address - Phone:814-849-3035
Practice Address - Fax:814-849-4341
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100761043Medicaid
PA045375Medicare UPIN