MEDICARE: DR. MARSHALL L CHAMBLISS MD

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	207Q00000X	Family Medicine Physician	9600329	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	14725	OTHER	NC	PARTNERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4308504	OTHER	NC	AETNA
2	21961	OTHER	NC	BCBSNC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	64949	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1629026471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL L CHAMBLISS MD

Provider Business Mailing Address
First Line	:	1125 N CHURCH ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1007
Country	:	US
Telephone Number	:	336-832-8035
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 N CHURCH ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1007
Country	:	US
Telephone Number	:	336-832-8035
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	09/24/2021

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