Healthcare Provider Details

I. General information

NPI: 1447457684
Provider Name (Legal Business Name): MARVIN M CHASSIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD 106
MESA AZ
85202-4768
US

IV. Provider business mailing address

1432 S DOBSON RD 106
MESA AZ
85202-4768
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-3637
  • Fax: 480-969-6568
Mailing address:
  • Phone: 480-969-3637
  • Fax: 480-969-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE CASILLAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-969-4634