Provider Demographics
NPI:1003854761
Name:MAO, CHENG-AN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHENG-AN
Middle Name:
Last Name:MAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 ALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1943
Mailing Address - Country:US
Mailing Address - Phone:862-249-4904
Mailing Address - Fax:862-249-4903
Practice Address - Street 1:871 ALLWOOD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1943
Practice Address - Country:US
Practice Address - Phone:862-249-4904
Practice Address - Fax:862-249-4903
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA062794207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1984962OtherUHC
NJ6955002Medicaid
10212OtherAMERIGROUP
2189814001OtherAMERIHEALTH
60034428OtherHORIZON NJ HEALTH
080182037OtherRAILROAD MEDICARE
133674OtherAETNA CAPITATION
677235OtherAETNA HMO
P2540460OtherOXFORD
2K1553OtherHEALTHNET
5998308OtherGHI
5120373OtherAETNA
PS000004003OtherAMERICHOICE
677235OtherAETNA HMO
NJ6955002Medicaid