MEDICARE: ARISTIDES E CHACONAS 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	2084N0400X	Neurology Physician	36162	SC
2	2084N0400X	Neurology Physician	9701712	NC

General Provider Information

NPI Number	:	1710954359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARISTIDES E CHACONAS MD

Provider Business Mailing Address
First Line	:	411 BILLINGSLEY RD STE 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1066
Country	:	US
Telephone Number	:	704-577-3186
Fax Number	:	704-626-2701

Provider Business Practice Location Address
First Line	:	411 BILLINGSLEY RD STE 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1066
Country	:	US
Telephone Number	:	704-577-3186
Fax Number	:	704-626-2701

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	12/01/2023

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Directions to “ ARISTIDES E CHACONAS MD” Practice Location

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