Provider Demographics
NPI:1144269622
Name:CHAPPELL, HERIMONE LESTRITA (MD)
Entity type:Individual
Prefix:
First Name:HERIMONE
Middle Name:LESTRITA
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HERIMONE
Other - Middle Name:LESTRITA
Other - Last Name:CHAPPELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8301
Mailing Address - Country:US
Mailing Address - Phone:937-298-5333
Mailing Address - Fax:937-298-5923
Practice Address - Street 1:3033 KETTERING BLVD
Practice Address - Street 2:SUITE213
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-1962
Practice Address - Country:US
Practice Address - Phone:937-298-5333
Practice Address - Fax:937-298-5923
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-068248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0146649Medicaid
OH0146649Medicaid
TE0783051Medicare ID - Type Unspecified