MEDICARE: AI-EN CHU THLICK 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	207R00000X	Internal Medicine Physician	MD431886	PA

General Provider Information

NPI Number	:	1649335811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AI-EN CHU THLICK MD

Provider Business Mailing Address
First Line	:	4533 NEW FALLS RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19056-3004
Country	:	US
Telephone Number	:	267-540-8220
Fax Number	:	609-537-7072

Provider Business Practice Location Address
First Line	:	4533 NEW FALLS RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19056-3004
Country	:	US
Telephone Number	:	267-540-8220
Fax Number	:	609-537-7072

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	10/27/2022

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