=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699775585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STUART ROSS CHIPKIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2005
-----------------------------------------------------
Last Update Date | 03/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 HALL DR
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01002-2751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-256-8561
-----------------------------------------------------
Fax | 866-644-0869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 HALL DR
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-256-8561
-----------------------------------------------------
Fax | 866-644-0869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 52718
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------