Provider Demographics
NPI:1669652590
Name:ALAIN G CHAMPALOUX, MD
Entity Type:Organization
Organization Name:ALAIN G CHAMPALOUX, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHAMPALOUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-627-3500
Mailing Address - Street 1:14314 OLD MARLBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2840
Mailing Address - Country:US
Mailing Address - Phone:301-627-3500
Mailing Address - Fax:301-627-1634
Practice Address - Street 1:14314 OLD MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2840
Practice Address - Country:US
Practice Address - Phone:301-627-3500
Practice Address - Fax:301-627-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD101061100Medicaid
G00216Medicare PIN