Provider Demographics
NPI:1811906365
Name:CHAPPELL, PHILLIP BRANCH (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:BRANCH
Last Name:CHAPPELL
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 1:153 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437
Mailing Address - Country:US
Mailing Address - Phone:203-457-9049
Mailing Address - Fax:860-715-7527
Practice Address - Street 1:230 SOUTH FRONTAGE ROAD
Practice Address - Street 2:YALE UNIVERSITY CHILD STUDY CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-7900
Practice Address - Country:US
Practice Address - Phone:203-785-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0281002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E90199Medicare UPIN