Healthcare Provider Details

I. General information

NPI: 1568081321
Provider Name (Legal Business Name): BRIAN CHEA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
CONCORD NH
03301-2548
US

IV. Provider business mailing address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-1725
  • Fax: 603-227-7557
Mailing address:
  • Phone: 603-224-1725
  • Fax: 603-227-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1720
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: