Provider Demographics
NPI:1326692112
Name:CHAS MEDICINE LLC
Entity Type:Organization
Organization Name:CHAS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:STANISLAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-245-4858
Mailing Address - Street 1:34435 KING STREET ROW STE 3
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4787
Mailing Address - Country:US
Mailing Address - Phone:302-245-4858
Mailing Address - Fax:
Practice Address - Street 1:34435 KING STREET ROW STE 3
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4787
Practice Address - Country:US
Practice Address - Phone:302-245-4858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720067747OtherINDIVIDUAL NPI