Provider Demographics
NPI:1700884616
Name:CHASE, BRADLEY COLEMAN (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:COLEMAN
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 1:4 PHYSICIANS PARK
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4181
Mailing Address - Country:US
Mailing Address - Phone:502-223-8400
Mailing Address - Fax:502-875-3073
Practice Address - Street 1:4 PHYSICIANS PARK
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4181
Practice Address - Country:US
Practice Address - Phone:502-223-8400
Practice Address - Fax:502-875-3073
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32316208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201069130Medicaid
KY64323165Medicaid
KYK043050Medicare PIN
KY64323165Medicaid
KY693102Medicare PIN