Provider Demographics
NPI:1619958550
Name:CHEN, CLIFFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
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 1:1026 DUQUESNE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUQUESNE
Mailing Address - State:PA
Mailing Address - Zip Code:15110-1404
Mailing Address - Country:US
Mailing Address - Phone:412-469-3627
Mailing Address - Fax:412-469-0926
Practice Address - Street 1:1713 ARDMORE BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4405
Practice Address - Country:US
Practice Address - Phone:412-247-3222
Practice Address - Fax:412-247-3229
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA085214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100207Medicaid
PAP000368Medicaid
PA01729880Medicaid
PA894316Medicare ID - Type UnspecifiedCHEN
PA01729880Medicaid