Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD069155L | PA |
NPI | 1023048683 |
---|---|
Provider Name | Lan X Chen |
First Address | Blue Bell, PA 19422-1636 |
Second Address | Philadelphia, PA 19104-3149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 27/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018734080004 | (05) | PA |
H55839 | (02) |