Healthcare Provider Details

I. General information

NPI: 1992372445
Provider Name (Legal Business Name): KEVIN P CHASE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1193 NORTON AVE STE A
NORTON OH
44203-9526
US

IV. Provider business mailing address

1193 NORTON AVE STE A
NORTON OH
44203-9526
US

V. Phone/Fax

Practice location:
  • Phone: 330-825-1152
  • Fax: 740-689-6759
Mailing address:
  • Phone: 330-825-0847
  • Fax: 330-825-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.017392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: