Healthcare Provider Details

I. General information

NPI: 1649098252
Provider Name (Legal Business Name): ALEXA CHAPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD FL 15
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

227 SORREL DR
MORGANVILLE NJ
07751-4081
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-4000
  • Fax:
Mailing address:
  • Phone: 732-740-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00883400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA065963
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: