Provider Demographics
NPI:1508858358
Name:CHASE, JOSEPH MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:CHASE
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 1:4465 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1854
Mailing Address - Country:US
Mailing Address - Phone:330-688-9501
Mailing Address - Fax:330-688-9510
Practice Address - Street 1:4465 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1854
Practice Address - Country:US
Practice Address - Phone:330-688-9501
Practice Address - Fax:330-688-9510
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2672808Medicaid
P00334956Medicare PIN
4203652Medicare PIN
OH2672808Medicaid