Provider Demographics
NPI:1467474866
Name:CHAO, JEROME DONALD (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:DONALD
Last Name:CHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13 CENTURY HILL DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2113
Mailing Address - Country:US
Mailing Address - Phone:518-203-2582
Mailing Address - Fax:518-203-2583
Practice Address - Street 1:13 CENTURY HILL DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2113
Practice Address - Country:US
Practice Address - Phone:518-203-2582
Practice Address - Fax:518-203-2583
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY224758-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02429110Medicaid
NYH91557Medicare UPIN