Basic Information
Provider Information | |||||||||
NPI: | 1720008840 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHAMBERLAIN | ||||||||
FirstName: | JOSETTE | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HUNTER | ||||||||
OtherFirstName: | JOSETTE | ||||||||
OtherMiddleName: | L | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 40 | ||||||||
Address2: |   | ||||||||
City: | CARIBOU | ||||||||
State: | ME | ||||||||
PostalCode: | 047360040 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2074982359 | ||||||||
FaxNumber: | 2074983947 | ||||||||
Practice Location | |||||||||
Address1: | 163 VAN BUREN RD | ||||||||
Address2: |   | ||||||||
City: | CARIBOU | ||||||||
State: | ME | ||||||||
PostalCode: | 047363567 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2074986921 | ||||||||
FaxNumber: | 2074981697 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2006 | ||||||||
LastUpdateDate: | 12/13/2017 | ||||||||
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 | 015327 | ME | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 02475 | 01 | ME | ATENA-NON | OTHER | 12/5/2006 | 01 | ME | CIGNA | OTHER | 291380099 | 05 | ME |   | MEDICAID | 5626631 | 01 | ME | ATENA-HMO | OTHER | 2426734 06 | 01 | ME | UNITED HEALTH CARE | OTHER | 4/25/2007 | 01 | ME | HEALTHNET | OTHER | 11/20/2006 | 01 | ME | HARVARD PILGRIM | OTHER | 10/16/2006 | 01 | ME | MARTINS POINT | OTHER | 8/4/2006 | 01 | ME | BENEFIT SERVICES | OTHER |