Basic Information
| Provider Information | |||||||||
| NPI: | 1902880081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAUVENET | ||||||||
| FirstName: | ALLEN | ||||||||
| MiddleName: | RUSSELL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 PENNSYLVANIA AVENUE SUITE 103 | ||||||||
| Address2: | WEST VIRGINIA UNIVERSITY | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881552 | ||||||||
| FaxNumber: | 3043882084 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 PENNSYLVANIA AVENUE | ||||||||
| Address2: | WEST VIRGINIA UNIVERSITY | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881552 | ||||||||
| FaxNumber: | 3043882084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 01/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | 22776 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2053799A | 05 | WV | MEDICAID |