Provider Demographics
NPI:1538116611
Name:CHATELAIN, MARTIN P (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:P
Last Name:CHATELAIN
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 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-371-5765
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-996-3664
Practice Address - Fax:501-996-0536
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06249800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7782004Medicaid
NJP00795664OtherRR MEDICARE
NJG09382Medicare UPIN
NJ785668ZFPYMedicare PIN
NJ785668Medicare ID - Type Unspecified