Healthcare Provider Details

I. General information

NPI: 1790780351
Provider Name (Legal Business Name): RICHARD M CHASEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD STE 210
LAUREL MD
20707-5268
US

IV. Provider business mailing address

10770 COLUMBIA PIKE STE 400
SILVER SPRING MD
20901-4462
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-5500
  • Fax: 301-498-7346
Mailing address:
  • Phone: 240-485-5210
  • Fax: 301-625-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0022862
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: