Provider Demographics
NPI:1720061252
Name:CHAZAN, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:CHAZAN
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 1:318 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914
Mailing Address - Country:US
Mailing Address - Phone:401-438-5950
Mailing Address - Fax:401-435-2245
Practice Address - Street 1:318 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-438-5950
Practice Address - Fax:401-435-2245
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD03892207RN0300X
MA27981207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0782279OtherAETNA
RI7000732Medicaid
MA2161851Medicaid
RI3892OtherBCBS
MAR01062OtherBCBS
0735784002OtherCIGNA
RI1059OtherNEIGHBORHOOD HLT. RI
003892OtherTUFTS
RI201161OtherBLUE CHIP
3100101OtherUNITED HEALTH
390001776OtherRAILROAD MEDIC
MAR01062OtherBCBS
0782279OtherAETNA
3100101OtherUNITED HEALTH