Provider Demographics
NPI:1154988004
Name:CHACE HANKINS, KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CHACE HANKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 NEW RD FL 1
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1013
Mailing Address - Country:US
Mailing Address - Phone:609-383-6450
Mailing Address - Fax:
Practice Address - Street 1:2110 NEW RD FL 1
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1013
Practice Address - Country:US
Practice Address - Phone:609-383-6450
Practice Address - Fax:609-383-6451
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP04583208800000X
NJ25MA12276900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology