Provider Demographics
NPI:1194755314
Name:GUNNLAUGSSON, CHAD B (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:B
Last Name:GUNNLAUGSSON
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 1:1040 PINNACLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5735
Mailing Address - Country:US
Mailing Address - Phone:803-509-7200
Mailing Address - Fax:803-509-7213
Practice Address - Street 1:1040 PINNACLE POINT DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5735
Practice Address - Country:US
Practice Address - Phone:803-509-7200
Practice Address - Fax:803-509-7213
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28760207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC287601Medicaid
SC287601Medicaid
SC287601Medicaid
SCH87981Medicare UPIN