Provider Demographics
NPI:1902880081
Name:CHAUVENET, ALLEN RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:RUSSELL
Last Name:CHAUVENET
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 1:830 PENNSYLVANIA AVENUE SUITE 103
Mailing Address - Street 2:WEST VIRGINIA UNIVERSITY
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302
Mailing Address - Country:US
Mailing Address - Phone:304-388-1552
Mailing Address - Fax:304-388-2084
Practice Address - Street 1:830 PENNSYLVANIA AVENUE
Practice Address - Street 2:WEST VIRGINIA UNIVERSITY
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-388-1552
Practice Address - Fax:304-388-2084
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV227762080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2053799AMedicaid
WV2053799AMedicaid