Provider Demographics
NPI:1386606036
Name:CHANCEY, MICHAEL HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HOWARD
Last Name:CHANCEY
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 1:415 MORRIS ST STE 304
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1853
Mailing Address - Country:US
Mailing Address - Phone:304-388-7783
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:301 RHL
Practice Address - Street 2:SUITE 301
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8291
Practice Address - Country:US
Practice Address - Phone:304-388-7010
Practice Address - Fax:304-388-7015
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13496208000000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0112540-000Medicaid
020039000OtherRAILROAD MEDICARE
WV0112540-000Medicaid
CH0840183Medicare PIN
D98019Medicare UPIN
CH0629368Medicare PIN
020039000Medicare PIN