Provider Demographics
NPI:1205152584
Name:CHAPUT, CHRISTINE MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:CHAPUT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:HAMELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:33 CANAL ST
Mailing Address - Street 2:PO BOX 315
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9605
Mailing Address - Country:US
Mailing Address - Phone:860-658-1058
Mailing Address - Fax:860-658-1819
Practice Address - Street 1:33 CANAL ST
Practice Address - Street 2:
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-9605
Practice Address - Country:US
Practice Address - Phone:860-658-1058
Practice Address - Fax:860-658-1819
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT052286208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program