Basic Information
| Provider Information | |||||||||
| NPI: | 1417062373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAPMAN | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | ANNE STATLER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 GIBSON BLVD SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871084729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052627594 | ||||||||
| FaxNumber: | 5058657641 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 GIBSON BLVD SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871084729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052627594 | ||||||||
| FaxNumber: | 5052627641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 08/17/2011 | ||||||||
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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 | 208000000X | MD2008-0653 | NM | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 22858229 | 05 | NM | MEDICAID |