1811094220 NPI number — WILLIAM RAYMOND CHASSE MD

Table of content: WILLIAM RAYMOND CHASSE MD (NPI 1811094220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811094220 NPI number — WILLIAM RAYMOND CHASSE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHASSE
Provider First Name:
WILLIAM
Provider Middle Name:
RAYMOND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811094220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 B KENNEDY MEMORIAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERVILLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-873-0737
Provider Business Mailing Address Fax Number:
207-861-5446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 B KENNEDY MEMORIAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-873-0737
Provider Business Practice Location Address Fax Number:
207-861-5446
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  11743 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001940 . This is a "ANTHEM PIN 001940" identifier . This identifiers is of the category "OTHER".
  • Identifier: M60981 . This is a "PIN M60981 GROUP M60980" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114590099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114590000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040001080 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".