Healthcare Provider Details

I. General information

NPI: 1588620322
Provider Name (Legal Business Name): JUNG-MING CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MEMORIAL DR SUITE 203
LEOMINSTER MA
01453-2238
US

IV. Provider business mailing address

502 LINDELL AVE
LEOMINSTER MA
01453-5452
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-9488
  • Fax: 978-534-3552
Mailing address:
  • Phone: 978-534-9198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number45238
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: