Basic Information
| Provider Information | |||||||||
| NPI: | 1033191333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAFEL | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 SE HOSPITAL AVE | ||||||||
| Address2: | PATHOLOGY DEPARTMENT | ||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349942346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722885853 | ||||||||
| FaxNumber: | 7722885885 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 SE HOSPITAL AVE | ||||||||
| Address2: | PATHOLOGY DEPARTMENT | ||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349942346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722885853 | ||||||||
| FaxNumber: | 7722885885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 03/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | ME71788 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 257563900 | 05 | FL | MEDICAID | 47185 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |