Provider Demographics
NPI:1114936770
Name:CHAPDELAINE, PERRY ANTHONY JR (MD)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:ANTHONY
Last Name:CHAPDELAINE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 WARD CIRCLE
Mailing Address - Street 2:SUITE B12
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7518
Mailing Address - Country:US
Mailing Address - Phone:615-377-6767
Mailing Address - Fax:615-377-6768
Practice Address - Street 1:229 WARD CIRCLE
Practice Address - Street 2:SUITE B12
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7518
Practice Address - Country:US
Practice Address - Phone:615-377-6767
Practice Address - Fax:615-377-6768
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000208382083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4071527Medicaid
3090123Medicare ID - Type Unspecified
G00812Medicare UPIN