Provider Demographics
NPI:1578628806
Name:CHEN, LEI (MD)
Entity Type:Individual
Prefix:
First Name:LEI
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 JOHNSONBURG RD
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3480
Mailing Address - Country:US
Mailing Address - Phone:814-834-6139
Mailing Address - Fax:814-781-3571
Practice Address - Street 1:761 JOHNSONBURG RD
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3480
Practice Address - Country:US
Practice Address - Phone:814-834-6139
Practice Address - Fax:814-781-3571
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070734L207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018010510001Medicaid
PAH20772Medicare UPIN
PA0018010510001Medicaid