Provider Demographics
NPI:1053948083
Name:CHAO, COLIN NEILS
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:NEILS
Last Name:CHAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 E PETTIGREW ST APT 836
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4863
Mailing Address - Country:US
Mailing Address - Phone:919-627-3082
Mailing Address - Fax:
Practice Address - Street 1:1565 ORCHARD VILLAS AVE
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4321
Practice Address - Country:US
Practice Address - Phone:919-752-5342
Practice Address - Fax:919-367-9276
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-02177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty