Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 00887 | MD |
NPI | 1023142072 |
---|---|
Provider Name | Richard I Chase |
First Address | Monkton, MD 21111-0374 |
Second Address | Baltimore, MD 21217-3119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 14/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
357668000 | (05) | MD |
T041 | BLUE CROSS BLUE SHIELD (01) | MD |
T59811 | (02) | MD |