Healthcare Provider Details

I. General information

NPI: 1710080056
Provider Name (Legal Business Name): ROBERT THADDEAUS CHAPDELAINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N BROADWAY STE 500
PENNSVILLE NJ
08070-1257
US

IV. Provider business mailing address

90 MATAWAN RD STE 302
MATAWAN NJ
07747-2653
US

V. Phone/Fax

Practice location:
  • Phone: 856-691-2211
  • Fax: 856-839-4128
Mailing address:
  • Phone: 732-441-7177
  • Fax: 732-441-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25MA08129700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: