Provider Demographics
NPI:1760123442
Name:DAVIS, CHANDLER (DO)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 CANYON RIDGE RD APT 206
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-1264
Mailing Address - Country:US
Mailing Address - Phone:757-784-7144
Mailing Address - Fax:
Practice Address - Street 1:500 J. CLYDE MORRIS BLVD
Practice Address - Street 2:DEPT. OF MEDICAL EDUCATION
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601
Practice Address - Country:US
Practice Address - Phone:757-612-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program