Basic Information
Provider Information
NPI: 1962609024
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHASE
FirstName: KARIN
MiddleName: SUSANNE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 601 ELMWOOD AVE BOX SURG
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5857849649
FaxNumber:  
Practice Location
Address1: 601 ELMWOOD AVE
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5852765384
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/29/2007
LastUpdateDate: 06/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X254542NYN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207RC0200X25452NYN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RC0200X254542NYY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


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