Provider Demographics
NPI:1154586741
Name:CHAPARRO, FREDY O (MD)
Entity type:Individual
Prefix:DR
First Name:FREDY
Middle Name:O
Last Name:CHAPARRO
Suffix:
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 1:100 E LANCASTER AVE
Mailing Address - Street 2:MOB EAST 556
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3435
Mailing Address - Country:US
Mailing Address - Phone:610-896-0210
Mailing Address - Fax:610-896-5101
Practice Address - Street 1:100 E LANCASTER AVE STE 556
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3435
Practice Address - Country:US
Practice Address - Phone:610-896-0210
Practice Address - Fax:610-896-5101
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459512207RI0200X
IL036.127484207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103234427001Medicaid