Provider Demographics
NPI:1649215948
Name:CHANCELLOR PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:CHANCELLOR PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:AMORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-786-9771
Mailing Address - Street 1:12006 KILARNEY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7207
Mailing Address - Country:US
Mailing Address - Phone:540-786-9771
Mailing Address - Fax:540-548-8806
Practice Address - Street 1:12006 KILARNEY DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7207
Practice Address - Country:US
Practice Address - Phone:540-786-9771
Practice Address - Fax:540-548-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101228664208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty