Provider Demographics
NPI:1811962137
Name:CHIAPETTA, VANESSA L (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:CHIAPETTA
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 1:12221 MOPAC EXPRESSWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2483
Mailing Address - Country:US
Mailing Address - Phone:512-334-2504
Mailing Address - Fax:512-334-2594
Practice Address - Street 1:5701 W SLAUGHTER LN BLDG C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-6528
Practice Address - Country:US
Practice Address - Phone:512-334-2504
Practice Address - Fax:512-334-2594
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9301208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105939602Medicaid
TX370007428Medicare PIN
TX88G236Medicare PIN
TX8L25566Medicare PIN
TX105939602Medicaid