Provider Demographics
NPI:1255329157
Name:CHASE, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:CHASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CYPRESS ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3600
Mailing Address - Country:US
Mailing Address - Phone:603-663-8200
Mailing Address - Fax:603-663-8209
Practice Address - Street 1:445 CYPRESS ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3600
Practice Address - Country:US
Practice Address - Phone:603-663-8200
Practice Address - Fax:603-663-8209
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH11618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2811669OtherAETNA
NH3738398OtherCIGNA
NH30201169Medicaid
04-05848OtherUHC
NH159502OtherTUFTS
NHG94506OtherHPHC
NHG94506OtherANTHEM UPIN REFERRAL #
NH101115806OtherW/C DEPT OF LABOR PIN
110235536OtherRR MEDICARE
NH01YP03861NH01OtherANTHEM ACES #
G94506Medicare UPIN
NHRE6699Medicare ID - Type UnspecifiedMEDICARE