Provider Demographics
NPI:1669445441
Name:CHASSIN, MARVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:M
Last Name:CHASSIN
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:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4769
Practice Address - Country:US
Practice Address - Phone:480-969-3637
Practice Address - Fax:480-969-6568
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10566207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ214255Medicaid
AZZ149590Medicare PIN