Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA062794 | NJ |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA062794 | NJ |
NPI | 1003854761 |
---|---|
Provider Name | Dr. Cheng-An Mao |
First Address | Clifton, NJ 07012-1943 |
Second Address | Clifton, NJ 07012-1943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 10/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080182037 | RAILROAD MEDICARE (01) | |
10212 | AMERIGROUP (01) | |
133674 | AETNA CAPITATION (01) | |
1984962 | UHC (01) | |
2189814001 | AMERIHEALTH (01) | |
2K1553 | HEALTHNET (01) | |
5120373 | AETNA (01) | |
5998308 | GHI (01) | |
60034428 | HORIZON NJ HEALTH (01) | |
677235 | AETNA HMO (01) | |
6955002 | (05) | NJ |
G33180 | (02) | NJ |
P2540460 | OXFORD (01) | |
PS000004003 | AMERICHOICE (01) |