Provider Demographics
NPI: | 1457393241 |
---|---|
Name: | CHAPADOS, RENE ANN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | RENE |
Middle Name: | ANN |
Last Name: | CHAPADOS |
Suffix: | |
Gender: | F |
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 917770 |
Mailing Address - Street 2: | |
Mailing Address - City: | ORLANDO |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32891-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1033 DR MARTIN LUTHER KING JR ST N |
Practice Address - Street 2: | SUITE 108 |
Practice Address - City: | ST PETERSBURG |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33701-1547 |
Practice Address - Country: | US |
Practice Address - Phone: | 727-456-3288 |
Practice Address - Fax: | 727-456-3289 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-13 |
Last Update Date: | 2020-10-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME83335 | 2080P0203X, 208M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 03826Z | Other | MEDICARE PTAN |
FL | 03286 | Other | BLUE CROSS BLUE SHIELD |
FL | 262588100 | Medicaid |