Provider Demographics
NPI:1427842764
Name:CHAMBERLAIN, BENJAMIN ANTHONY
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ANTHONY
Last Name:CHAMBERLAIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 PERKINSVILLE DR APT 105A
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5351
Mailing Address - Country:US
Mailing Address - Phone:980-423-9178
Mailing Address - Fax:
Practice Address - Street 1:397 PERKINSVILLE DR APT 105A
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5351
Practice Address - Country:US
Practice Address - Phone:980-423-9178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer