Provider Demographics
NPI:1144602244
Name:CHEN, JACQUELINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 170
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4530
Mailing Address - Country:US
Mailing Address - Phone:301-668-9707
Mailing Address - Fax:301-668-4927
Practice Address - Street 1:141 THOMAS JOHNSON DR STE 170
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-668-9707
Practice Address - Fax:301-668-4927
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10458213ES0103X
MD01634213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD01634OtherMARYLAND LICENSE