Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401415927 | VA |
Y | 213EG0000X | General Practice | 0401415927 | VA |
N | 1223G0001X | General Practice | 6442 | NV |
N | 213EG0000X | General Practice | 6442 | NV |
NPI | 1003257239 |
---|---|
Provider Name | Dr. Brian J Chase |
First Address | Sterling, VA 20164-6641 |
Second Address | Sterling, VA 20164-6641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2013 |
Last Update Date | 13/04/2018 |