Provider Demographics
NPI:1962439612
Name:CHAFFEY, JOHN ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:CHAFFEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 TOLLGATE ROAD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-825-8200
Mailing Address - Fax:401-825-8281
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-825-8200
Practice Address - Fax:401-825-8281
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIH62600Medicare UPIN
RI007010554Medicare ID - Type Unspecified