Provider Demographics
NPI:1811564628
Name:CHASE, CARTER W (MD)
Entity type:Individual
Prefix:DR
First Name:CARTER
Middle Name:W
Last Name:CHASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 E 7TH ST STE F
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2518
Practice Address - Country:US
Practice Address - Phone:260-925-0403
Practice Address - Fax:260-925-9545
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11021674A207Q00000X
IN01088231A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine