Healthcare Provider Details

I. General information

NPI: 1780549998
Provider Name (Legal Business Name): MARK CHASE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 CAREW ST
SPRINGFIELD MA
01104-2306
US

IV. Provider business mailing address

417 CAREW ST
SPRINGFIELD MA
01104-2306
US

V. Phone/Fax

Practice location:
  • Phone: 413-834-2689
  • Fax:
Mailing address:
  • Phone: 413-834-2689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN211503
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: