Provider Demographics
NPI:1356395453
Name:CHAMBERLAIN, SCOTT (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:CHAMBERLAIN
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 1:612 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2732
Mailing Address - Country:US
Mailing Address - Phone:704-210-5190
Mailing Address - Fax:
Practice Address - Street 1:1990 N CALIFORNIA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-7249
Practice Address - Country:US
Practice Address - Phone:925-225-5837
Practice Address - Fax:925-225-2834
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501198207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21932OtherBLUE CROSS
NCP00205735OtherRAILROAD MEDICARE
NC5900046Medicaid
NC21932OtherBLUE CROSS
NCE84372Medicare UPIN