Healthcare Provider Details

I. General information

NPI: 1881847598
Provider Name (Legal Business Name): BRIAN CHASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2008
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARRISH ST
CANANDAIGUA NY
14424-1731
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-6129
  • Fax: 585-396-6603
Mailing address:
  • Phone: 330-492-6400
  • Fax: 330-244-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberN/A
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number253515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: