Provider Demographics
NPI:1376534552
Name:CHEN, JOHN W (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:GRAY 2 NEURORADIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-8323
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRB 285
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8320
Practice Address - Fax:617-724-3338
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2082132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469043OtherTUFTS HEALTH PLAN
MA2039711Medicaid
MAJ27237OtherBCBS MA
MAJ27237OtherBCBS MA
MA2039711Medicaid