Healthcare Provider Details

I. General information

NPI: 1245313311
Provider Name (Legal Business Name): STEPHEN M CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 WILKES RIDGE PKWY STE 201
RICHMOND VA
23233-7460
US

IV. Provider business mailing address

14401 SOMMERVILLE CT
MIDLOTHIAN VA
23113-6836
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-4115
  • Fax:
Mailing address:
  • Phone: 804-285-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101057890
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: