Provider Demographics
NPI:1750482733
Name:CHAPMAN, LACIA ROCHELLE (MD)
Entity Type:Individual
Prefix:
First Name:LACIA
Middle Name:ROCHELLE
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 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:786-530-3150
Mailing Address - Fax:786-530-3150
Practice Address - Street 1:549 E BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2905
Practice Address - Country:US
Practice Address - Phone:786-530-3150
Practice Address - Fax:786-530-3150
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27332207Q00000X
VA0101243389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731741Medicaid
NE47068731734Medicaid
NE47068731798Medicaid
NE10026480100Medicaid
NE47068731749Medicaid
IA1750482733Medicaid
NE099099285Medicare PIN