Provider Demographics
NPI:1568455806
Name:CHINAVARE, BRIAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:CHINAVARE
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 1:855 W MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2764
Mailing Address - Country:US
Mailing Address - Phone:419-228-7432
Mailing Address - Fax:419-228-5628
Practice Address - Street 1:855 W MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2764
Practice Address - Country:US
Practice Address - Phone:419-228-7432
Practice Address - Fax:419-228-5628
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH076679207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2166918Medicaid
H05059Medicare UPIN
OH2166918Medicaid
OH9310793Medicare PIN
MIP00460714Medicare PIN
OH0885563Medicare PIN
MI0N14190Medicare PIN
OH9310791Medicare PIN
MIN14190004Medicare PIN
MI4420667Medicaid
OH0885564Medicare PIN