=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174502504
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA XINYUE LIU-CHEN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2006
-----------------------------------------------------
Last Update Date | 07/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 HITCHCOCK WAY. DEPT OF INTERNAL MEDICINE, DARTMOUTH HITCHCOCK CLINICS
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-695-2600
-----------------------------------------------------
Fax | 603-308-1470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 HITCHCOCK WAY. DEPT OF INTERNAL MEDICINE, DARTMOUTH HITCHCOCK CLINICS
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-695-2600
-----------------------------------------------------
Fax | 603-308-1470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 242474
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 242474
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 24027
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------