Provider Demographics
NPI:1033100235
Name:DEMOTT, CHAD J (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:J
Last Name:DEMOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 BELLEVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-853-0442
Mailing Address - Fax:540-983-1133
Practice Address - Street 1:1906 BELLEVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016
Practice Address - Country:US
Practice Address - Phone:540-853-0442
Practice Address - Fax:540-983-1133
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-237636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010174619Medicaid
VA010174601Medicaid
VA010174627Medicaid
007864C21Medicare PIN
007865C19Medicare PIN
VA010174619Medicaid