Provider Demographics
NPI:1841452406
Name:RARIY, CHEVON M (MD)
Entity type:Individual
Prefix:DR
First Name:CHEVON
Middle Name:M
Last Name:RARIY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHEVON
Other - Middle Name:M
Other - Last Name:HASWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CANCER TREATMENT CENTERS OF AMERICA
Mailing Address - Street 2:2361 PAYSPHERE CIRCLE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:
Practice Address - Street 1:14780 W MOUNTAIN VIEW BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7280
Practice Address - Country:US
Practice Address - Phone:623-215-9460
Practice Address - Fax:623-282-3576
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.150497207RE0101X
PAMD440962207R00000X
PAMT193443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTPME6276OtherTELEHEALTH REGISTRATION NUMBER
AZ59284OtherMEDICAL LICENSE
1841452406OtherNPI