Provider Demographics
NPI:1104187327
Name:CONNOR, CHELSEA AMANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:AMANDA
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1002 N CHURCH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1449
Mailing Address - Country:US
Mailing Address - Phone:336-387-8100
Mailing Address - Fax:336-387-8202
Practice Address - Street 1:1002 N CHURCH ST STE 302
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1449
Practice Address - Country:US
Practice Address - Phone:336-387-8100
Practice Address - Fax:336-387-8202
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD.34738 LL208600000X
NC2017-00723208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104187327Medicaid