Individual
CHANDLER FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-0816
(434) 924-9400
(434) 982-1618
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
(434) 295-1000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101278936
VA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
0101278936
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2017
Last updated
08/21/2023
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