Provider Demographics
NPI:1982626370
Name:CHUA, ANNABELLE NANCY (MD)
Entity Type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:NANCY
Last Name:CHUA
Suffix:
Gender:F
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:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-381-8840
Mailing Address - Fax:704-381-8848
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:MEDICAL CENTER PLAZA, SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5866
Practice Address - Country:US
Practice Address - Phone:704-381-8840
Practice Address - Fax:704-381-8848
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2289208000000X
NC852762080P0210X
NC2000013562080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1928Medicaid
NC1982626370Medicaid
NC1982626370Medicaid
TX8C0700Medicare PIN
TXTXB118697Medicare PIN
TX8G7088Medicare PIN
NCNCE762AMedicare PIN
TX8L0300Medicare PIN