Provider Demographics
NPI:1376668228
Name:CHASON, JUDDSON T (MD)
Entity Type:Individual
Prefix:
First Name:JUDDSON
Middle Name:T
Last Name:CHASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RIDGELY AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1001
Mailing Address - Country:US
Mailing Address - Phone:410-266-8049
Mailing Address - Fax:
Practice Address - Street 1:600 RIDGELY AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1001
Practice Address - Country:US
Practice Address - Phone:410-266-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD72475208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program