Provider Demographics
NPI:1063428225
Name:CHASE, RANDOLPH H (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:H
Last Name:CHASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-668-2851
Mailing Address - Fax:415-387-6533
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:SUITE 608
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-668-2851
Practice Address - Fax:415-387-6533
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG33463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG33463OtherCALIFORNIA LICENSE NUMBER
CA00G334630Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAG33463OtherCALIFORNIA LICENSE NUMBER