Provider Demographics
NPI:1891776019
Name:CHAPIN, CLIFFORD ARTHUR (MD)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:ARTHUR
Last Name:CHAPIN
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 1:512 SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1199
Mailing Address - Country:US
Mailing Address - Phone:218-879-4641
Mailing Address - Fax:218-878-7086
Practice Address - Street 1:512 SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1199
Practice Address - Country:US
Practice Address - Phone:218-879-4641
Practice Address - Fax:218-878-7086
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA37351OtherHARVARD PILGRIM
01Y0072420VH03OtherANTHEM
NH421750814OtherTAX ID
VT785935OtherMVP
VT1009726OtherVTW
NH30204411Medicaid
VT68117OtherVT BLUE
NH26568OtherCIGNA
HI5070OtherTRICARE
NHS01Y007242NH02OtherNH
NH26568OtherCIGNA
NH30204411Medicaid