MEDICARE: JOSEPH CHEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207QS0010X	Sports Medicine (Family Medicine) Physician	89753	SC

General Provider Information

NPI Number	:	1619592649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CHEN MD

Provider Business Mailing Address
First Line	:	PO BOX 946383
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30394-6383
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 HOSPITAL DR STE 110
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2453
Country	:	US
Telephone Number	:	386-586-1910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	11/14/2024

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