Healthcare Provider Details

I. General information

NPI: 1447247457
Provider Name (Legal Business Name): MARK WILLIAM CHEWNING M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HIGHLAND AVE SE SUITE 200
ROANOKE VA
24013-2201
US

IV. Provider business mailing address

21 HIGHLAND AVE SE SUITE 200
ROANOKE VA
24013-2201
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-8881
  • Fax: 540-982-0501
Mailing address:
  • Phone: 540-982-8881
  • Fax: 540-982-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101237869
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: