Provider Demographics
NPI:1821056680
Name:RUNYAN, CHADLEY MILTON (MD)
Entity Type:Individual
Prefix:
First Name:CHADLEY
Middle Name:MILTON
Last Name:RUNYAN
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7092
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:1005 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2707
Practice Address - Country:US
Practice Address - Phone:843-777-7900
Practice Address - Fax:843-777-7925
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34688207QS0010X
OH87605207QS0010X
MI4301074767207QS0010X
WV20909207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC346888Medicaid
WV300441700Medicaid
SC346888Medicaid
SCAA9615-1271Medicare UPIN