Provider Demographics
NPI:1013212505
Name:JAY I. CHASON
Entity Type:Organization
Organization Name:JAY I. CHASON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMASNKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-857-2802
Mailing Address - Street 1:15 E MAIN ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5000
Mailing Address - Country:US
Mailing Address - Phone:410-857-2802
Mailing Address - Fax:410-857-2803
Practice Address - Street 1:15 E MAIN ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5000
Practice Address - Country:US
Practice Address - Phone:410-857-2802
Practice Address - Fax:410-857-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD498941400Medicaid
MDU36060Medicare UPIN
MDV502Medicare PIN