Healthcare Provider Details

I. General information

NPI: 1699739938
Provider Name (Legal Business Name): MR. THOMAS HARRY CHASE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE VETERANS HOSPITAL
CLARKSBURG WV
26301
US

IV. Provider business mailing address

RR 3 BOX228
GRAFTON WV
26354-9803
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax: 304-623-7776
Mailing address:
  • Phone: 304-265-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1003693
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: