Basic Information
| Provider Information | |||||||||
| NPI: | 1245224989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAVARRIA-AGUILAR | ||||||||
| FirstName: | MARCO | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602373 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282131500 | ||||||||
| FaxNumber: | 8286516570 | ||||||||
| Practice Location | |||||||||
| Address1: | 1409 ASHEVILLE HWY | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287129524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284358490 | ||||||||
| FaxNumber: | 8284358401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 2016-00176 | NC | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | 2016-00176 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8312689 | 01 | NC | PRIME HEALTH SERVICES | OTHER | 3813585 | 01 | NC | CIGNA | OTHER | 7617141 | 01 | NC | PRIME HEALTH SERVICES | OTHER | NCT527B | 01 | NC | MEDICARE PTAN | OTHER | 19JF5 | 01 | NC | BCBS | OTHER |