1538204219 NPI number — DR. CHEUNJU CHEN M.D.

Table of content: DR. CHEUNJU CHEN M.D. (NPI 1538204219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538204219 NPI number — DR. CHEUNJU CHEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEN
Provider First Name:
CHEUNJU
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHENS
Provider Other First Name:
CHENJU
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1538204219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3421 CONCORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-9001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-797-9240
Provider Business Mailing Address Fax Number:
301-797-4234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 WESTERN MARYLAND PKWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-5471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-797-9240
Provider Business Practice Location Address Fax Number:
301-797-4234
Provider Enumeration Date:
02/21/2007

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: 2084N0400X , with the licence number:  D0067013 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 92575701 . This is a "MARYLAND BLUE SHIELD-PPN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 414186500 . This is a "MARYLAND MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W2660018 . This is a "MARYLAND BLUE SHIELD-REGIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2016137 . This is a "HIGHMARK BLUE SHIELD-MD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2013145 . This is a "HIGHMARK BLUE SHIELD-PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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