Provider Demographics
NPI:1376523837
Name:CHU, MYRON (DO)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 RENAISSANCE BLVD
Mailing Address - Street 2:RN0320
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2772
Mailing Address - Country:US
Mailing Address - Phone:610-787-3490
Mailing Address - Fax:610-787-7043
Practice Address - Street 1:2301 RENAISSANCE BLVD
Practice Address - Street 2:RN0320
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2772
Practice Address - Country:US
Practice Address - Phone:610-787-3490
Practice Address - Fax:610-787-7043
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB07157800207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8460108Medicaid
NJ046546Medicare ID - Type Unspecified
NJ8460108Medicaid