Provider Demographics
NPI:1811564628
Name:CHASE, CARTER WILLIAM HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:WILLIAM HAROLD
Last Name:CHASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 BROADWAY STE 350
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1412
Practice Address - Country:US
Practice Address - Phone:260-423-2675
Practice Address - Fax:260-423-6621
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11021674A207Q00000X
IN01088231A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine