=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386655132
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHOCK TSERING M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 07/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 ELLEN ST
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28112-5173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-283-8811
-----------------------------------------------------
Fax | 866-339-8381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 734
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28111-0734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-283-8811
-----------------------------------------------------
Fax | 704-283-2980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 200100798
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------