Provider Demographics
NPI:1255326757
Name:CHAVEZ, ROLANDO M (MD)
Entity Type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:M
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2951 WEST FRONT STREET
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-596-6655
Mailing Address - Fax:276-596-6657
Practice Address - Street 1:2951 WEST FRONT STREET
Practice Address - Street 2:SUITE 1800
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-596-6655
Practice Address - Fax:276-596-6657
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101030778208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10053625Medicaid
VA10053625Medicaid
VAB06251Medicare UPIN