1588620322 NPI number — JUNG-MING CHEN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588620322 NPI number — JUNG-MING CHEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEN
Provider First Name:
JUNG-MING
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1588620322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 LINDELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEOMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01453-5452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-534-9198
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-534-9488
Provider Business Practice Location Address Fax Number:
978-534-3552
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146D00000X , with the licence number:  45238 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 045238 . This is a "TUFTS HEALTH INS." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 130586 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 149440 . This is a "HEALTH SOURCE MASSACHUSSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 18392 . This is a "UNICARE HEALTH INS." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0107212 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0326 . This is a "CENTRAL MASS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 07-03063 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014374 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4953 . This is a "FALLON HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S012044 . This is a "CHAMPUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 36072 . This is a "HEALTHY START PROGRAM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 98798701 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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