Basic Information
| Provider Information | |||||||||
| NPI: | 1063480663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAO | ||||||||
| FirstName: | DARREN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1046 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458021046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192245707 | ||||||||
| FaxNumber: | 4192290040 | ||||||||
| Practice Location | |||||||||
| Address1: | 433 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435061690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196361131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 06/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35.077637 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 208D00000X | 35.077637 | OH | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 2168934 | 05 | OH | MEDICAID | 300108868 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000135702 | 01 | OH | ANTHEM BCBS | OTHER | 300108869 | 01 | OH | RAILROAD MEDICARE | OTHER | 4235800 | 05 | MI | MEDICAID | 300108867 | 01 | OH | RAILROAD MEDICARE | OTHER | 4300945 | 05 | MI | MEDICAID | 300108870 | 01 | OH | RAILROAD MEDICARE | OTHER |