1710245931 NPI number — DR. JASON ANDREW CHIN M.D.

Table of content: DR. JASON ANDREW CHIN M.D. (NPI 1710245931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710245931 NPI number — DR. JASON ANDREW CHIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIN
Provider First Name:
JASON
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1710245931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 N CALVERT ST, JPB #325
Provider Second Line Business Mailing Address:
MEDSTAR UNION MEMORIAL HOSPITAL
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-554-2950
Provider Business Mailing Address Fax Number:
410-261-8226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 N CALVERT ST
Provider Second Line Business Practice Location Address:
JOHNSTON PROFESSIONAL BUILDING 325
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-554-4324
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2012

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: 2086S0129X , with the licence number:  D0085133 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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