Healthcare Provider Details

I. General information

NPI: 1841302593
Provider Name (Legal Business Name): MARY DICKINSON CHAMBERLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DARTMOUTH-HITCHCOCK MEDICAL CENTER - NCCC
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DARTMOUTH-HITCHCOCK MEDICAL CENTER - NCCC
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-6181
  • Fax:
Mailing address:
  • Phone: 603-653-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number042-0010644
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number12056
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: