Healthcare Provider Details

I. General information

NPI: 1013232149
Provider Name (Legal Business Name): XIN CHEN OMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W PATRICK ST
FREDERICK MD
21701-5514
US

IV. Provider business mailing address

2118 WALNUT RIDGE CT
FREDERICK MD
21702-5921
US

V. Phone/Fax

Practice location:
  • Phone: 301-693-8968
  • Fax:
Mailing address:
  • Phone: 301-668-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01359
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: