Healthcare Provider Details

I. General information

NPI: 1891792727
Provider Name (Legal Business Name): CHAU-FANG CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHAU FANG CHEN M.D.

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N JAMES ST
ROME NY
13440-2844
US

IV. Provider business mailing address

PO BOX 772
ROME NY
13442-0772
US

V. Phone/Fax

Practice location:
  • Phone: 315-336-6716
  • Fax:
Mailing address:
  • Phone: 315-336-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number134917
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: