MEDICARE: ADD/ADHD DIAGNOSTIC AND TREATMENT CENTER, PA

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	207Q00000X	Family Medicine Physician	N1045	TX
2	207Q00000X	Family Medicine Physician	N4349	TX

General Provider Information

NPI Number	:	1346509320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADD/ADHD DIAGNOSTIC AND TREATMENT CENTER, PA

Provider Business Mailing Address
First Line	:	PO BOX 261283
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75026-1283
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 INDEPENDENCE PKWY
Second Line	:	SUITE # A-1
City	:	PLANO
State	:	TX
Zip	:	75075-6406
Country	:	US
Telephone Number	:	972-943-0410
Fax Number	:	972-212-4270

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JOHN CHUANG
Credential	:
Telephone Number	:	832-202-6368

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/10/2012

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