Provider Demographics
NPI:1811954712
Name:CHASSE, THOMAS A (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:CHASSE
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 1:320 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0244
Mailing Address - Country:US
Mailing Address - Phone:912-427-7790
Mailing Address - Fax:
Practice Address - Street 1:194 PLEASANT ST STE 2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2952
Practice Address - Country:US
Practice Address - Phone:603-224-2353
Practice Address - Fax:603-226-0727
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063305207Y00000X
NMMD2013-0125207Y00000X
ME011959207Y00000X
MA55754207Y00000X
NH8956207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131980000Medicaid
GA003148873AMedicaid
NM186000751Medicaid
NH30002649Medicaid
GA003148873AMedicaid
NM282396YKTNMedicare PIN
NH30002649Medicaid