Provider Demographics
NPI:1023142072
Name:CHASE, RICHARD I (OWNER)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:I
Last Name:CHASE
Suffix:
Gender:M
Credentials:OWNER
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 374
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-0374
Mailing Address - Country:US
Mailing Address - Phone:443-522-9479
Mailing Address - Fax:443-522-9725
Practice Address - Street 1:1721 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3119
Practice Address - Country:US
Practice Address - Phone:410-523-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00887213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD357668000Medicaid
MDT041OtherBLUE CROSS BLUE SHIELD
MD4207170001Medicare NSC
MDT041OtherBLUE CROSS BLUE SHIELD
MD357668000Medicaid