Provider Demographics
NPI:1144402793
Name:SANTOS, CHAUNCEY B (MD)
Entity Type:Individual
Prefix:
First Name:CHAUNCEY
Middle Name:B
Last Name:SANTOS
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 490
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-0490
Mailing Address - Country:US
Mailing Address - Phone:706-951-8241
Mailing Address - Fax:276-596-6717
Practice Address - Street 1:6719 GOV G C PEERY HWY
Practice Address - Street 2:SUITE 1000
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-0880
Practice Address - Country:US
Practice Address - Phone:276-596-6715
Practice Address - Fax:276-596-6717
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30089207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135PYMedicaid
NC2024514Medicare PIN
NCD41050Medicare UPIN