Basic Information
| Provider Information | |||||||||
| NPI: | 1790706224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERS | ||||||||
| FirstName: | DANA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 249 | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286130249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284652231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 212 29TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286011130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284852762 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01081188A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD16441 | RI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101265788 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R9733 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 9800805 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11511 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | CN8132 | 01 | NC | MEDICARE RAILROAD | OTHER | 891234E | 05 | NC | MEDICAID |