Provider Demographics
NPI:1861661506
Name:CHANCE, DORIS MARIE (PA)
Entity Type:Individual
Prefix:MISS
First Name:DORIS
Middle Name:MARIE
Last Name:CHANCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 EDEN WAY N STE 102
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0745
Mailing Address - Country:US
Mailing Address - Phone:757-216-4030
Mailing Address - Fax:757-216-4029
Practice Address - Street 1:808 EDEN WAY N STE 102
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0745
Practice Address - Country:US
Practice Address - Phone:757-216-4030
Practice Address - Fax:757-216-4029
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001235363A00000X
FLPA9104654363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant