Provider Demographics
NPI:1407800550
Name:CHEN, PHYLLIS M (MD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:M
Last Name:CHEN
Suffix:
Gender:F
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:EMERGENCY DEPT., WHIDDEN MEMORIAL HOSPITAL
Mailing Address - Street 2:103 GARLAND STREET
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149
Mailing Address - Country:US
Mailing Address - Phone:617-389-6270
Mailing Address - Fax:
Practice Address - Street 1:EMERGENCY DEPT., WHIDDEN MEMORIAL HOSPITAL
Practice Address - Street 2:103 GARLAND STREET
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149
Practice Address - Country:US
Practice Address - Phone:617-389-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223658207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2104725Medicaid
MAG04622Medicare UPIN
MAA38456Medicare ID - Type Unspecified