Healthcare Provider Details

I. General information

NPI: 1932360955
Provider Name (Legal Business Name): CHAD D LAVENDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 12/08/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS ST SUITE 201
CHARLESTON WV
25301-1842
US

IV. Provider business mailing address

300 CORPORATE CENTER DRIVE
SCOTT DEPOT WV
25560
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7700
  • Fax: 304-388-7755
Mailing address:
  • Phone: 304-691-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24375
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: