Provider Demographics
NPI:1073502233
Name:CHAMBERLAIN, KERRY E (DO)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:E
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN; CREDENTIAL DEPARTMENT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:100 HIGHLAND AVE NE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2542
Practice Address - Country:US
Practice Address - Phone:727-683-2900
Practice Address - Fax:727-683-2901
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5728207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038215900Medicaid
FL038215900Medicaid
FL80200WMedicare PIN
FL80200VMedicare PIN
FL1168350001Medicare NSC
FL038215900Medicaid