Healthcare Provider Details

I. General information

NPI: 1144017716
Provider Name (Legal Business Name): CHARLES LAAIR CHASE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 FOREST DR STE 160
ANNAPOLIS MD
21401-4211
US

IV. Provider business mailing address

1750 FOREST DR
ANNAPOLIS MD
21401-4211
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: