Provider Demographics
NPI:1720069354
Name:CHACONAS, GEORGE H (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
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 1:6675 BOOKER T WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WIRTZ
Mailing Address - State:VA
Mailing Address - Zip Code:24184-4128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6675 BOOKER T WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:WIRTZ
Practice Address - State:VA
Practice Address - Zip Code:24184-4128
Practice Address - Country:US
Practice Address - Phone:540-721-2118
Practice Address - Fax:540-721-6448
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-038267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5623758Medicaid
D75257Medicare UPIN
080005672Medicare ID - Type Unspecified
VA017860C18Medicare PIN
080005672Medicare PIN