Healthcare Provider Details

I. General information

NPI: 1295776615
Provider Name (Legal Business Name): GERARD NMN CHASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOLIVAR DR
BERKELEY CA
94710-2210
US

IV. Provider business mailing address

801 ACALANES RD
LAFAYETTE CA
94549-3301
US

V. Phone/Fax

Practice location:
  • Phone: 510-486-8744
  • Fax: 510-649-0322
Mailing address:
  • Phone: 925-283-3387
  • Fax: 925-283-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG4862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: