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General NPI Number Information
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NPI Number | 1609339480
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Entity Type | Individual
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Provider Name | MR. CHARLES EDRICK ONG CHUA
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Gender | Male
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 2700 REMINGTON AVE STE 2000
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City | BALTIMORE
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State | MD
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Zip | 21211-3037
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Country | US
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Telephone | 667-312-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0100826
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA11514500
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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