Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DS018475L | PA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS018475L | PA |
NPI | 1588634877 |
---|---|
Provider Name | Dr. J. Frederick Chairsell |
First Address | Lancaster, PA 17603-2353 |
Second Address | Lancaster, PA 17603-2353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 02/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1730835 | (05) | PA |
231944530 | TAX ID (01) | PA |
32271 | BLUE SHIELD ID NUMBER (01) | PA |
T28628 | (02) | PA |