Healthcare Provider Details

I. General information

NPI: 1215927504
Provider Name (Legal Business Name): ALVIN C CHUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CENTRAL STREET
BROOKFIELD MA
01506-0699
US

IV. Provider business mailing address

PO BOX K299 18 CENTRAL STREET
BROOKFIELD MA
01506-0699
US

V. Phone/Fax

Practice location:
  • Phone: 508-867-9891
  • Fax: 508-867-7385
Mailing address:
  • Phone: 508-867-9891
  • Fax: 508-867-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49566
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number49566
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: