=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023162625
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ALLYN CHAPMAN MA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3564 HEINDEL RD YORK COUNTY YOUTH DEVELOPMENT CENTER
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-840-7570
-----------------------------------------------------
Fax | 717-840-7281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 MAYBERRY LANE
-----------------------------------------------------
City | MECHANICSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-514-4228
-----------------------------------------------------
Fax | 717-796-9622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PS007082L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------