MEDICARE: CHASIDY JONES CPT

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	207ZH0000X	Hematology (Pathology) Physician	14-03-2041T	OH

General Provider Information

NPI Number	:	1548085616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASIDY JONES CPT

Provider Business Mailing Address
First Line	:	679 E 127TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-2441
Country	:	US
Telephone Number	:	216-399-6910
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 LEE RD STE 337
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3427
Country	:	US
Telephone Number	:	216-243-1311
Fax Number	:

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

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	11/22/2024

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