Provider Demographics
NPI:1972594489
Name:CHANCELLOR, VELLA V (MD)
Entity type:Individual
Prefix:
First Name:VELLA
Middle Name:V
Last Name:CHANCELLOR
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 1:2800 E. BROAD STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:817-477-9292
Mailing Address - Fax:817-473-9787
Practice Address - Street 1:2800 E. BROAD STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-477-9292
Practice Address - Fax:817-473-9787
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1443207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00SY33OtherBCBS
TX035911901Medicaid
TX2221774OtherBLUE LINK
TX2221774OtherBLUE LINK
TX2221774OtherBLUE LINK
TN00SY33OtherBCBS