Basic Information
| Provider Information | |||||||||
| NPI: | 1336126572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMBERLAIN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601884 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804872800 | ||||||||
| FaxNumber: | 7044870186 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 W GROVER ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281503825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804872800 | ||||||||
| FaxNumber: | 7044870186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 03/05/2014 | ||||||||
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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 | 28477 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 21889 | 01 | BCBS | OTHER | 21989 | 01 | MEDCOST | OTHER | 2036101 | 01 | AETNA US HEALTH | OTHER | 8921889 | 05 | NC | MEDICAID | 1336126572 | 05 | NC | MEDICAID | 4299208 | 01 | AETNA | OTHER | N28477 | 05 | SC | MEDICAID | 560943383B | 01 | CIGNA | OTHER | 741490 | 01 | UHC | OTHER | 160021404 | 01 | RAILROAD MEDICARE | OTHER | 291784 | 01 | MAMSI | OTHER | AC2917356 | 01 | DEA | OTHER |