Healthcare Provider Details

I. General information

NPI: 1750349957
Provider Name (Legal Business Name): BERTRAND G CHAPMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W GROVE ST STE 201
MIDDLEBORO MA
02346
US

IV. Provider business mailing address

511 W GROVE ST STE 201
MIDDLEBORO MA
02346
US

V. Phone/Fax

Practice location:
  • Phone: 508-947-7610
  • Fax: 508-946-2691
Mailing address:
  • Phone: 508-947-7610
  • Fax: 508-946-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43452
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: