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General NPI Number Information
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NPI Number | 1710080056
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Entity Type | Individual
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Provider Name | ROBERT THADDEAUS CHAPDELAINE MD
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 390 N BROADWAY STE 500
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City | PENNSVILLE
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State | NJ
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Zip | 08070-1257
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Country | US
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Telephone | 856-691-2211
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Fax | 856-839-4128
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Provider Business Mailing Address
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Address Line | 90 MATAWAN RD STE 302
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City | MATAWAN
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State | NJ
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Zip | 07747-2653
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Country | US
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Telephone | 732-441-7177
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Fax | 732-441-7165
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 25MA08129700
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License Number State | NJ
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