Healthcare Provider Details

I. General information

NPI: 1619958550
Provider Name (Legal Business Name): CLIFFORD CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 ARDMORE BLVD
PITTSBURGH PA
15221-4405
US

IV. Provider business mailing address

1026 DUQUESNE BLVD
DUQUESNE PA
15110-1404
US

V. Phone/Fax

Practice location:
  • Phone: 412-247-3222
  • Fax: 412-247-3229
Mailing address:
  • Phone: 412-469-3627
  • Fax: 412-469-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number085214
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: