1073502985 NPI number — CHU J CHEN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073502985 NPI number — CHU J CHEN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CHEN

Provider First Name:

CHU

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1073502985

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/25/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

221 BOSTON RD

Provider Second Line Business Mailing Address:

SUITE 8

Provider Business Mailing Address City Name:

BILLERICA

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01862-2321

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

978-667-9611

Provider Business Mailing Address Fax Number:

978-667-2282

Provider First Line Business Practice Location Address:

221 BOSTON RD

Provider Second Line Business Practice Location Address:

SUITE 8

Provider Business Practice Location Address City Name:

BILLERICA

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01862-2321

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

978-667-9611

Provider Business Practice Location Address Fax Number:

978-667-2282

Provider Enumeration Date:

10/14/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  57307 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 991492 . This is a "NETWORK HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 20580 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: B10050701 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 12-00890 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: MDP003 . This is a "SIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 3017711 . This is a "MASS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 30200269 . This is a "EDS FEDERAL CORPORATION" identifier . This identifiers is of the category "OTHER".
• Identifier: J06555 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0019017 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 042484572003 . This is a "DISABILITY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 75519 . This is a "AETNA US HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 057307 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 3017711 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".