Provider Demographics
NPI:1063672988
Name:CHANCE, AMANDA VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:VICTORIA
Last Name:CHANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9628 7TH BAY ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-1204
Mailing Address - Country:US
Mailing Address - Phone:646-251-1992
Mailing Address - Fax:646-251-1992
Practice Address - Street 1:9628 7TH BAY ST UNIT A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518
Practice Address - Country:US
Practice Address - Phone:646-251-1992
Practice Address - Fax:646-251-1992
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101249214OtherLICENSE NUMBER