Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 038648 | CT |
Y | 2080P0204X | Pediatric Emergency Doctor | 038648 | CT |
NPI | 1124002142 |
---|---|
Provider Name | Lei Chen |
First Address | New Haven, CT 06510-3220 |
Second Address | New Haven, CT 06519-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 24/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001386483 | (05) | CT |
H30351 | (02) |