Healthcare Provider Details

I. General information

NPI: 1942415716
Provider Name (Legal Business Name): LEE CHADRICK CHUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S 54TH ST ICU DEPARTMENT
PHILADELPHIA PA
19143-1900
US

IV. Provider business mailing address

118 N OHIO TRL
MEDFORD NJ
08055-9037
US

V. Phone/Fax

Practice location:
  • Phone: 866-344-0543
  • Fax: 866-344-3934
Mailing address:
  • Phone: 856-685-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD439980
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD439980
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD439980
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: