Provider Demographics
NPI:1841251980
Name:CHAMBLISS, PAUL DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DEAN
Last Name:CHAMBLISS
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 1:645 10TH AVENUE
Mailing Address - Street 2:RYAN CHELSEA CLINTON COMMUNITY HEALTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2904
Mailing Address - Country:US
Mailing Address - Phone:212-265-4500
Mailing Address - Fax:212-265-6565
Practice Address - Street 1:645 10TH AVENUE
Practice Address - Street 2:RYAN CHELSEA CLINTON COMMUNITY HEALTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2904
Practice Address - Country:US
Practice Address - Phone:212-265-4500
Practice Address - Fax:212-265-6565
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216441207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I00152Medicare UPIN
NY202AX1Medicare ID - Type Unspecified