Provider Demographics
NPI:1134304017
Name:CHEN, RICHARD ELLIOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ELLIOTT
Last Name:CHEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27331 TOWN WALK DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3777
Mailing Address - Country:US
Mailing Address - Phone:203-859-5065
Mailing Address - Fax:
Practice Address - Street 1:27331 TOWN WALK DR
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3777
Practice Address - Country:US
Practice Address - Phone:203-859-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant