Healthcare Provider Details

I. General information

NPI: 1619970704
Provider Name (Legal Business Name): RICK ALLEN CHAMBERLAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 SANDCREST BLVD #D
COLUMBUS IN
47203
US

IV. Provider business mailing address

3809 WAYCROSS DRIVE
COLUMBUS IN
47203
US

V. Phone/Fax

Practice location:
  • Phone: 812-900-1272
  • Fax:
Mailing address:
  • Phone: 812-390-0042
  • Fax: 317-398-1852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01038230A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.044870
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: