Healthcare Provider Details

I. General information

NPI: 1386606036
Provider Name (Legal Business Name): MICHAEL HOWARD CHANCEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RHL SUITE 301
CHARLESTON WV
25309-8291
US

IV. Provider business mailing address

415 MORRIS ST STE 304
CHARLESTON WV
25301-1853
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7010
  • Fax: 304-388-7015
Mailing address:
  • Phone: 304-388-7783
  • Fax: 304-388-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13496
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13496
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: