Healthcare Provider Details

I. General information

NPI: 1255326757
Provider Name (Legal Business Name): ROLANDO M CHAVEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 WEST FRONT STREET SUITE 1800
RICHLANDS VA
24641
US

IV. Provider business mailing address

2951 WEST FRONT STREET SUITE 1800
RICHLANDS VA
24641
US

V. Phone/Fax

Practice location:
  • Phone: 276-596-6655
  • Fax: 276-596-6657
Mailing address:
  • Phone: 276-596-6655
  • Fax: 276-596-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101030778
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: