MEDICARE: LANCE CHILTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	72-15	NM

General Provider Information

NPI Number	:	1821005869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE CHILTON MD

Provider Business Mailing Address
First Line	:	306 SAN PABLO ST SE STE A
Second Line	:	MSC10 5590
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-3167
Country	:	US
Telephone Number	:	505-272-9242
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 SAN PABLO ST SE STE A
Second Line	:	MSC10 5590
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-3167
Country	:	US
Telephone Number	:	505-272-9242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	05/02/2012

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Directions to “ LANCE CHILTON MD” Practice Location

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