Provider Demographics
NPI:1912961202
Name:LANCASTER, CHAD J
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:J
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 ELK ST
Mailing Address - Street 2:PO BOX 307
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-1113
Mailing Address - Country:US
Mailing Address - Phone:304-364-8565
Mailing Address - Fax:
Practice Address - Street 1:715 ELK ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1113
Practice Address - Country:US
Practice Address - Phone:304-364-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000354Medicaid