Provider Demographics
NPI:1538459219
Name:CENTER FOR ADVANCED LIPID MANAGEMENT
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED LIPID MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACONAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-588-7115
Mailing Address - Street 1:38 PEAKS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-2566
Mailing Address - Country:US
Mailing Address - Phone:540-588-7115
Mailing Address - Fax:
Practice Address - Street 1:4806 PLEASANT HILL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3441
Practice Address - Country:US
Practice Address - Phone:540-588-7115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038267261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty