Provider Demographics
NPI:1740487727
Name:CHAPMAN JACKSON, EMME
Entity type:Individual
Prefix:
First Name:EMME
Middle Name:
Last Name:CHAPMAN JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMME
Other - Middle Name:DUSTIN
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1671
Mailing Address - Country:US
Mailing Address - Phone:240-964-8342
Mailing Address - Fax:240-964-8337
Practice Address - Street 1:12502 WILLOWBROOK RD STE 450
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6593
Practice Address - Country:US
Practice Address - Phone:240-964-8931
Practice Address - Fax:240-964-8932
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD78067208600000X, 208200000X
WVAS22959041519208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery