MEDICARE: RYAN F. CHAMBERS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA1599	WV

General Provider Information

NPI Number	:	1104461664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN F. CHAMBERS PA-C

Provider Business Mailing Address
First Line	:	3412 STAUNTON AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 STAUNTON AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1327
Country	:	US
Telephone Number	:	304-000-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	11/17/2025

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