Healthcare Provider Details

I. General information

NPI: 1225977903
Provider Name (Legal Business Name): COLLIN EDWARD TANCHANCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: COLLIN EDWARD TANCHANCO OCAMPO

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD STE 601
CHARLOTTE NC
28203-5871
US

IV. Provider business mailing address

2 RIVERSIDE CIR
ROANOKE VA
24016-4950
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-7874
  • Fax: 704-355-5619
Mailing address:
  • Phone: 571-309-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: