Healthcare Provider Details

I. General information

NPI: 1538104419
Provider Name (Legal Business Name): CHAPEL HILL INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 MARTIN LUTHER KING JR BLVD
CHAPEL HILL NC
27514-2601
US

IV. Provider business mailing address

940 MARTIN LUTHER KING JR BLVD
CHAPEL HILL NC
27514-2601
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-5123
  • Fax: 919-942-5730
Mailing address:
  • Phone: 919-942-5123
  • Fax: 919-942-5730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNE J CHAMBERLIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 919-951-0444