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General NPI Number Information
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NPI Number | 1225351927
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Entity Type | Organization
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Legal Business Name | BARRY CHANTRELLE MD INC
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 5801 CHRISTIE AVE 240
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City | EMERYVILLE
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State | CA
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Zip | 94608-1964
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Country | US
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Telephone | 510-451-8451
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Fax | 510-594-1724
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Provider Business Mailing Address
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Address Line | 5801 CHRISTIE AVE 240
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City | EMERYVILLE
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State | CA
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Zip | 94608-1964
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Country | US
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Telephone | 510-451-8451
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Fax | 510-594-1724
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARRY CHANTRELLE
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Credential | M.D.
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Telephone | 510-451-8451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G35119
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License Number State | CA
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