Basic Information
| Provider Information | |||||||||
| NPI: | 1982609574 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAFFEE | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 ARCH ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303767000 | ||||||||
| FaxNumber: | 3303761066 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 ARCH ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303767000 | ||||||||
| FaxNumber: | 3303761066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 10/05/2011 | ||||||||
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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 | 207RC0000X | 35053638C | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0792656 | 05 | OH | MEDICAID | 0673378 | 01 | OH | MEDICARE ID | OTHER | 0673377 | 01 | OH | MEDICARE ID | OTHER |