Provider Demographics
NPI:1043287634
Name:CHEN, HENRY H (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:H
Last Name:CHEN
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 1:622 S DEER LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5256
Mailing Address - Country:US
Mailing Address - Phone:618-351-0115
Mailing Address - Fax:
Practice Address - Street 1:GOOD SAMARITAN REGIONAL HEALTH CENTER
Practice Address - Street 2:605 N 12 ST
Practice Address - City:MT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864
Practice Address - Country:US
Practice Address - Phone:618-242-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL82547Medicare PIN
F26103Medicare UPIN
ILL82554Medicare PIN