Provider Demographics
NPI:1417950668
Name:CHEN, VICTOR W (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:W
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2432
Mailing Address - Country:US
Mailing Address - Phone:770-479-5535
Mailing Address - Fax:770-720-3294
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8019
Practice Address - Country:US
Practice Address - Phone:770-721-9630
Practice Address - Fax:770-721-9631
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200401183174400000X
GA057589207RP1001X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137V8Medicaid
NC89137V8Medicaid
GA202I669200Medicare PIN
NCI16721Medicare UPIN