Healthcare Provider Details

I. General information

NPI: 1740710011
Provider Name (Legal Business Name): CHANTELL ALBERT ALEXANDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 W HUDSON BLVD
GASTONIA NC
28052-6430
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-853-5010
  • Fax: 704-853-5251
Mailing address:
  • Phone: 704-874-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2022-00176
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2022-00176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: