Healthcare Provider Details

I. General information

NPI: 1053324244
Provider Name (Legal Business Name): NEIL T CHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 MASTHEAD STREET NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

3830 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4479
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-8889
  • Fax: 505-842-8886
Mailing address:
  • Phone: 505-842-8889
  • Fax: 505-842-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number96-31
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: