Provider Demographics
NPI:1467673186
Name:CHANCELLOR, JENNIFER ANN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:CHANCELLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRAIL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607
Mailing Address - Country:US
Mailing Address - Phone:919-781-5510
Mailing Address - Fax:919-781-5053
Practice Address - Street 1:4414 LAKE BOONE TRAIL
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-781-5510
Practice Address - Fax:919-781-5053
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2008-00615174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist