Healthcare Provider Details

I. General information

NPI: 1679745657
Provider Name (Legal Business Name): ANDREA F. CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2008
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5053 S CONGRESS AVE STE 204
LAKE WORTH FL
33461-4706
US

IV. Provider business mailing address

5053 S CONGRESS AVE STE 204
LAKE WORTH FL
33461-4706
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-0222
  • Fax: 561-964-5500
Mailing address:
  • Phone: 561-965-0222
  • Fax: 561-964-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME113001
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME113001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: