Healthcare Provider Details

I. General information

NPI: 1417183583
Provider Name (Legal Business Name): GERARD B CHAMBERLIN MD MPH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6242 E ARBOR AVE STE 123
MESA AZ
85206-1309
US

IV. Provider business mailing address

6242 E ARBOR AVE STE 123
MESA AZ
85206-1309
US

V. Phone/Fax

Practice location:
  • Phone: 804-930-4600
  • Fax: 480-930-4615
Mailing address:
  • Phone: 480-930-4600
  • Fax: 480-993-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41160
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41160
License Number StateAZ

VIII. Authorized Official

Name: GERARD B CHAMBERLIN
Title or Position: PROPRIETOR
Credential: MD
Phone: 480-930-4600