MEDICARE: DR. GERARD NMN CHASE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G4862	CA

General Provider Information

NPI Number	:	1295776615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD NMN CHASE M.D.

Provider Business Mailing Address
First Line	:	801 ACALANES RD
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3301
Country	:	US
Telephone Number	:	925-283-3387
Fax Number	:	925-283-3387

Provider Business Practice Location Address
First Line	:	1 BOLIVAR DR
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2210
Country	:	US
Telephone Number	:	510-486-8744
Fax Number	:	510-649-0322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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