Healthcare Provider Details

I. General information

NPI: 1811949399
Provider Name (Legal Business Name): RICHARD JOSEPH CHADWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 HUDSON CT
SONOMA CA
95476
US

IV. Provider business mailing address

690 HUDSON CT
SONOMA CA
95476-7146
US

V. Phone/Fax

Practice location:
  • Phone: 707-849-6533
  • Fax:
Mailing address:
  • Phone: 707-849-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG27274
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License NumberG27274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: