Healthcare Provider Details

I. General information

NPI: 1740487727
Provider Name (Legal Business Name): EMME CHAPMAN JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMME DUSTIN CHAPMAN MD

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/18/2026
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12502 WILLOWBROOK RD STE 450
CUMBERLAND MD
21502-6593
US

IV. Provider business mailing address

PO BOX 1671
CUMBERLAND MD
21501-1671
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-8931
  • Fax: 240-964-8932
Mailing address:
  • Phone: 240-964-8342
  • Fax: 240-964-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD78067
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD78067
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberAS22959041519
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: