Provider Demographics
NPI:1093719023
Name:CHANALES, ALAN STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:STUART
Last Name:CHANALES
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:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1671
Mailing Address - Country:US
Mailing Address - Phone:240-964-8568
Mailing Address - Fax:240-964-8337
Practice Address - Street 1:15225 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3254
Practice Address - Country:US
Practice Address - Phone:301-330-0200
Practice Address - Fax:301-330-0202
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2022-03-30
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
MD29453207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAC9227821Medicaid
CH113992Medicare ID - Type Unspecified
MDAC9227821Medicaid