MEDICARE: DR. CHAD B GUNNLAUGSSON M.D.

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	207Y00000X	Otolaryngology Physician	28760	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194755314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD B GUNNLAUGSSON M.D.

Provider Business Mailing Address
First Line	:	1040 PINNACLE POINT DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5735
Country	:	US
Telephone Number	:	803-509-7200
Fax Number	:	803-509-7213

Provider Business Practice Location Address
First Line	:	1040 PINNACLE POINT DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5735
Country	:	US
Telephone Number	:	803-509-7200
Fax Number	:	803-509-7213

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	03/07/2023

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