Provider Demographics
NPI:1164654158
Name:CHEN, OLIVER (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:
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 1:10715 DOWNSVILLE PIKE
Mailing Address - Street 2:STE 103
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7240
Mailing Address - Country:US
Mailing Address - Phone:301-739-6144
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-739-6147
Practice Address - Fax:301-739-6163
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI626452085R0202X
MDD00800802085R0202X
PAMD4563342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD745110500Medicaid
MD446356YY4Medicare PIN
MD446356ZACWMedicare PIN