Provider Demographics
NPI:1790886216
Name:NED H. CHAMBERS, M.D. INC.
Entity Type:Organization
Organization Name:NED H. CHAMBERS, M.D. INC.
Other - Org Name:SHELTER ISLAND MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-223-2668
Mailing Address - Street 1:1370 ROSECRANS ST
Mailing Address - Street 2:STE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2638
Mailing Address - Country:US
Mailing Address - Phone:619-223-2668
Mailing Address - Fax:619-223-2698
Practice Address - Street 1:1370 ROSECRANS ST
Practice Address - Street 2:STE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2638
Practice Address - Country:US
Practice Address - Phone:619-223-2668
Practice Address - Fax:619-223-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CAA32874261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699015529OtherNPI