Basic Information
Provider Information | |||||||||
NPI: | 1174590814 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHAPPELL | ||||||||
FirstName: | PAT | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 120 CONNER DRIVE #101 | ||||||||
Address2: |   | ||||||||
City: | CHAPEL HILL | ||||||||
State: | NC | ||||||||
PostalCode: | 27514 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9199428571 | ||||||||
FaxNumber: | 9199426355 | ||||||||
Practice Location | |||||||||
Address1: | 120 CONNER DRIVE #101 | ||||||||
Address2: | CHAPEL HILL OBGYN | ||||||||
City: | CHAPEL HILL | ||||||||
State: | NC | ||||||||
PostalCode: | 27514 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9199428571 | ||||||||
FaxNumber: | 9199426355 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/01/2006 | ||||||||
LastUpdateDate: | 09/11/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 33476 | NC | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 1284186004 | 01 | NC | UHC | OTHER | 1533448 | 01 | NC | CIGNA | OTHER | 19040 | 01 | NC | BCBS | OTHER | 154776 | 01 | NC | WELLPATH | OTHER | 562142486 | 01 | NC | BEECHSTREET | OTHER | 8919404 | 05 | NC |   | MEDICAID | 2909670 | 01 | NC | AETNA | OTHER | 41894 | 01 | NC | MEDCOST | OTHER | 213689C | 01 | NC | MEDICARE PDC | OTHER |