MEDICARE: DR. CHUN-MING 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	261QA1903X	Ambulatory Surgical Clinic/Center	0101026300	VA

General Provider Information

NPI Number	:	1417961624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUN-MING CHEN M.D.

Provider Business Mailing Address
First Line	:	3084 STRATFORD CT
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5826
Country	:	US
Telephone Number	:	757-688-8568
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 CHURCHLAND BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5262
Country	:	US
Telephone Number	:	757-483-3030
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	01/15/2008

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