Healthcare Provider Details

I. General information

NPI: 1386026599
Provider Name (Legal Business Name): INA CHAPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 MICHIGAN AVE
BUFFALO NY
14203-1207
US

IV. Provider business mailing address

833 MICHIGAN AVE
BUFFALO NY
14203-1207
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-0032
  • Fax:
Mailing address:
  • Phone: 716-574-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: