Healthcare Provider Details

I. General information

NPI: 1649582214
Provider Name (Legal Business Name): CANDICE RACHELLE CHIPMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2010
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W COUNTY LINE RD STE 2
HATBORO PA
19040-1605
US

IV. Provider business mailing address

319 W COUNTY LINE RD STE 2
HATBORO PA
19040-1605
US

V. Phone/Fax

Practice location:
  • Phone: 215-559-6923
  • Fax: 215-559-6925
Mailing address:
  • Phone: 215-559-6923
  • Fax: 215-559-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number003731
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number285705
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD461798
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number127549
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: