Healthcare Provider Details

I. General information

NPI: 1710245931
Provider Name (Legal Business Name): JASON ANDREW CHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N CALVERT ST JOHNSTON PROFESSIONAL BUILDING 325
BALTIMORE MD
21218-2850
US

IV. Provider business mailing address

3333 N CALVERT ST, JPB #325 MEDSTAR UNION MEMORIAL HOSPITAL
BALTIMORE MD
21218
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-4324
  • Fax:
Mailing address:
  • Phone: 410-554-2950
  • Fax: 410-261-8226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0085133
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: