Healthcare Provider Details

I. General information

NPI: 1750624664
Provider Name (Legal Business Name): VIRGINIA PEARSON CHENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA ELAINE PEARSON MD

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 N RAVENSWOOD AVE STE 201
CHICAGO IL
60640-5201
US

IV. Provider business mailing address

4525 N RAVENSWOOD AVE STE 201
CHICAGO IL
60640-5201
US

V. Phone/Fax

Practice location:
  • Phone: 312-878-4520
  • Fax: 708-575-8311
Mailing address:
  • Phone: 312-878-4520
  • Fax: 708-575-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD460260
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.146318
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: