Provider Demographics
NPI:1679675938
Name:CHEN, EDWARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 OSTRUM STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1152
Mailing Address - Country:US
Mailing Address - Phone:610-866-2211
Mailing Address - Fax:610-866-5082
Practice Address - Street 1:701 OSTRUM STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1152
Practice Address - Country:US
Practice Address - Phone:610-866-2211
Practice Address - Fax:610-866-5082
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD040722E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011220170001Medicaid
PA0011220170001Medicaid
PA123515Medicare PIN