=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942415716
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEE CHADRICK CHUA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 04/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 S 54TH ST ICU DEPARTMENT
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19143-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-344-0543
-----------------------------------------------------
Fax | 866-344-3934
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 N OHIO TRL
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08055-9037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-685-3677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | MD439980
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD439980
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD439980
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------