Provider Demographics
NPI:1699739904
Name:MADDOX, CHAUNDRA J (MD)
Entity type:Individual
Prefix:
First Name:CHAUNDRA
Middle Name:J
Last Name:MADDOX
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 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1300
Mailing Address - Fax:304-691-1375
Practice Address - Street 1:1600 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 3500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3656
Practice Address - Country:US
Practice Address - Phone:304-691-1300
Practice Address - Fax:304-691-1375
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19854208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149642Medicaid
KY64000003Medicaid
WV6700369000Medicaid
WV4032662Medicare PIN
WVH26231Medicare UPIN
WV4032661Medicare ID - Type Unspecified