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General NPI Number Information
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NPI Number | 1326418237
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Entity Type | Organization
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Legal Business Name | MID-ATLANTIC PAIN SPECIALISTS, LLC
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 2466 E CHESTNUT AVE SUITE 2
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City | VINELAND
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State | NJ
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Zip | 08361-8486
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Country | US
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Telephone | 856-691-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 2466 E CHESTNUT AVE SUITE 2
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City | VINELAND
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State | NJ
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Zip | 08361-8486
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Country | US
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Telephone | 856-691-2211
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT T. CHAPDELAINE
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Credential | M.D.
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Telephone | 856-691-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00585900
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License Number State | NJ
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