Provider Demographics
NPI:1508864281
Name:CHAMBERLAIN, ALLAN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:SCOTT
Last Name:CHAMBERLAIN
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:PO BOX 4190
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-4190
Mailing Address - Country:US
Mailing Address - Phone:304-399-4405
Mailing Address - Fax:304-399-2526
Practice Address - Street 1:143 PEYTON STREET
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-697-2035
Practice Address - Fax:304-781-2643
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14608207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0091366000Medicaid
160056668OtherRR MEDICARE
000560137OtherMS/BC
000560137OtherMS/BC
A72517Medicare UPIN
WV0091366000Medicaid
0600582Medicare PIN