Provider Demographics
NPI:1073667085
Name:CHEN, ELLIOTT HO (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:HO
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:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:2 MEDICAL PARK RD STE 302
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6839
Practice Address - Country:US
Practice Address - Phone:803-545-5800
Practice Address - Fax:803-254-0821
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31379208200000X
OH35.090217208200000X
SCTL31379208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC313798Medicaid
OH751121OtherBUCKEYE MEDICAID
OH2770765Medicaid
OH417880OtherWELLCARE MEDICAID
OH000000225197OtherUNISON
OH9158077OtherAETNA
SC313798Medicaid
SCAA32861955Medicare PIN
OH417880OtherWELLCARE MEDICAID