Provider Demographics
NPI:1750593612
Name:CHANCE, ELIZABETH W (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:W
Last Name:CHANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-8921
Practice Address - Street 1:595 MARTHA JEFFERSON DR STE 280
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911
Practice Address - Country:US
Practice Address - Phone:434-654-8920
Practice Address - Fax:434-654-8921
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101251503207YS0123X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6216AMedicare PIN
VAP01637022Medicare PIN