MEDICARE: ROBERT CHIN JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	32664	NC
2	207RP1001X	Pulmonary Disease Physician	32664	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4198	OTHER	NC	PARTNERS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5644077	OTHER	NC	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	37223	OTHER	NC	MEDCOST
6	22354	OTHER	NC	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053396481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CHIN JR. MD

Provider Business Mailing Address
First Line	:	3001 LYNDHURST AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-4007
Country	:	US
Telephone Number	:	336-765-0383
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 LYNDHURST AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-4007
Country	:	US
Telephone Number	:	336-765-0383
Fax Number	:	336-760-6918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	04/08/2013

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Directions to “ ROBERT CHIN JR. MD” Practice Location

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