Provider Demographics
NPI:1710954359
Name:CHACONAS, ARISTIDES E (MD)
Entity Type:Individual
Prefix:
First Name:ARISTIDES
Middle Name:E
Last Name:CHACONAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BILLINGSLEY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1066
Mailing Address - Country:US
Mailing Address - Phone:704-577-3186
Mailing Address - Fax:704-626-2701
Practice Address - Street 1:411 BILLINGSLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1066
Practice Address - Country:US
Practice Address - Phone:704-577-3186
Practice Address - Fax:704-626-2701
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC361622084N0400X
NC97017122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891104LMedicaid
SCN01712Medicaid
NC1710954359Medicaid
NCF56889Medicare UPIN
NC891104LMedicaid
NC2027034AMedicare PIN
NC1710954359Medicaid