Healthcare Provider Details

I. General information

NPI: 1659534501
Provider Name (Legal Business Name): RYAN CHUA CHUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD SUITE 2A
LEOMINSTER MA
01453-2253
US

IV. Provider business mailing address

PO BOX 726
LEOMINSTER MA
01453-0726
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-2692
  • Fax:
Mailing address:
  • Phone: 978-466-2692
  • Fax: 978-466-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number237513
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number307929
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number254196
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: