Provider Demographics
NPI:1841586450
Name:PURNELL, CHAD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ALLEN
Last Name:PURNELL
Suffix:
Gender:M
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:PO BOX 8500 LOCKBOX 7642
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:724-433-1645
Mailing Address - Fax:
Practice Address - Street 1:2211 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3351
Practice Address - Country:US
Practice Address - Phone:813-281-8115
Practice Address - Fax:813-281-8656
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060058208200000X
IL036.1359662082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery