Provider Demographics
NPI:1801877345
Name:CHAUNCEY B SANTOS MD PC
Entity type:Organization
Organization Name:CHAUNCEY B SANTOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:336-846-1222
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-0880
Mailing Address - Country:US
Mailing Address - Phone:336-846-1222
Mailing Address - Fax:336-846-1224
Practice Address - Street 1:200 HOSPITAL AVE
Practice Address - Street 2:STE 2
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-0880
Practice Address - Country:US
Practice Address - Phone:336-846-1222
Practice Address - Fax:336-846-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30089207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135PYMedicaid
NC2024514Medicare PIN
NC89135PYMedicaid