Provider Demographics
NPI:1154645091
Name:CHAVES, ANTOINETTE (ND)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:
Last Name:CHAVES
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ARBOR ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1222
Mailing Address - Country:US
Mailing Address - Phone:860-798-3594
Mailing Address - Fax:860-838-6783
Practice Address - Street 1:56 ARBOR ST
Practice Address - Street 2:SUITE 311
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1222
Practice Address - Country:US
Practice Address - Phone:860-798-3594
Practice Address - Fax:860-838-6783
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine