Provider Demographics
NPI:1710080056
Name:CHAPDELAINE, ROBERT THADDEAUS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THADDEAUS
Last Name:CHAPDELAINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 MATAWAN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2653
Mailing Address - Country:US
Mailing Address - Phone:732-441-7177
Mailing Address - Fax:732-441-7165
Practice Address - Street 1:390 N BROADWAY STE 500
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1257
Practice Address - Country:US
Practice Address - Phone:856-691-2211
Practice Address - Fax:856-839-4128
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08129700208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine