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NPI Code Detail

MEDICARE: CHANCELLOR INTERNAL MEDICINE

MEDICARE: CHANCELLOR INTERNAL MEDICINE
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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1396773354
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHANCELLOR INTERNAL MEDICINE
Provider Business Mailing Address
First Line : 12006 KILARNEY DR
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22407-7207
Country : US
Telephone Number : 540-786-9771
Fax Number : 540-548-8803
Provider Business Practice Location Address
First Line : 12006 KILARNEY DR
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22407-7207
Country : US
Telephone Number : 540-786-9771
Fax Number : 540-548-8803
Authorized Official
Title or Position : PHYSICIAN
Name : RICHARD AMEEN
Credential : MD
Telephone Number : 540-786-9771
Provider Enumeration Date : 06/29/2006
Last Update Date : 11/16/2009

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Directions to “CHANCELLOR INTERNAL MEDICINE ” Practice Location

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