Provider Demographics
NPI:1982021341
Name:CHANDLER, MIA T (MD, MPH)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:T
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:VATRICE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-713-0947
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-5724
Practice Address - Country:US
Practice Address - Phone:336-713-4500
Practice Address - Fax:336-713-4501
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2713592080P0216X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program