Provider Demographics
NPI:1306856703
Name:GRIESSEL, CHANDA ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDA
Middle Name:ANNETTE
Last Name:GRIESSEL
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:150 KIMEL PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6992
Mailing Address - Country:US
Mailing Address - Phone:336-760-2240
Mailing Address - Fax:336-760-2239
Practice Address - Street 1:150 KIMEL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6992
Practice Address - Country:US
Practice Address - Phone:336-760-2240
Practice Address - Fax:336-760-2239
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200301236207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135CAMedicaid
2021594CMedicare PIN
NC89135CAMedicaid