Provider Demographics
NPI:1386652147
Name:CHEN, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10721 MAIN ST
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6907
Mailing Address - Country:US
Mailing Address - Phone:703-229-4455
Mailing Address - Fax:703-229-4454
Practice Address - Street 1:10721 MAIN ST
Practice Address - Street 2:SUITE 2500
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6914
Practice Address - Country:US
Practice Address - Phone:703-229-4455
Practice Address - Fax:703-229-4454
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101052553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110153972OtherRR MEDICARE
VA5812372Medicaid
VA5812372Medicaid
110153972OtherRR MEDICARE