Provider Demographics
NPI:1396773354
Name:CHANCELLOR INTERNAL MEDICINE
Entity type:Organization
Organization Name:CHANCELLOR INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEEN
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:540-548-8803
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:540-548-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08479Medicare PIN