MEDICARE: DR. DAVID WAYNE CHEN M.D.

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	207R00000X	Internal Medicine Physician	52179	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6365	OTHER	MA	HARVARD PILGRIM ID
3	52179	OTHER	MA	LICENSE

General Provider Information

NPI Number	:	1154381721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WAYNE CHEN M.D.

Provider Business Mailing Address
First Line	:	942 SOUTH ST
Second Line	:
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-2314
Country	:	US
Telephone Number	:	617-325-0520
Fax Number	:	617-325-9115

Provider Business Practice Location Address
First Line	:	942 SOUTH ST
Second Line	:
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-2314
Country	:	US
Telephone Number	:	617-325-0520
Fax Number	:	617-325-9047

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. DAVID WAYNE CHEN M.D.” Practice Location

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