Basic Information
| Provider Information | |||||||||
| NPI: | 1255383147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMPLIN | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4228 HOUMA BLVD | ||||||||
| Address2: | STE 410 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700063021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048833770 | ||||||||
| FaxNumber: | 5048833711 | ||||||||
| Practice Location | |||||||||
| Address1: | 4228 HOUMA BLVD | ||||||||
| Address2: | STE 410 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700063021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048833770 | ||||||||
| FaxNumber: | 5048833711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD09202R | LA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1997978 | 05 | LA | MEDICAID |