Provider Demographics
NPI:1851888770
Name:CHAMPLIN, JOSEPHINE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:MARIE
Last Name:CHAMPLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 MONTAUK HWY STE B
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2232
Mailing Address - Country:US
Mailing Address - Phone:631-878-2222
Mailing Address - Fax:
Practice Address - Street 1:504 MONTAUK HWY STE B
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-2232
Practice Address - Country:US
Practice Address - Phone:631-878-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine