Provider Demographics
NPI:1346676020
Name:CHASE, DANIEL ROSS (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROSS
Last Name:CHASE
Suffix:
Gender:M
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 WASHINGTON ST UNIT 411
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-5239
Mailing Address - Country:US
Mailing Address - Phone:413-454-2324
Mailing Address - Fax:303-617-2397
Practice Address - Street 1:3531 WASHINGTON ST UNIT 411
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-5239
Practice Address - Country:US
Practice Address - Phone:413-454-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MA4580-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171M00000XOther Service ProvidersCase Manager/Care Coordinator