Provider Demographics
NPI:1710643804
Name:CHEN, BO (MSA)
Entity Type:Individual
Prefix:DR
First Name:BO
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10234 HERON POND TER
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3736
Mailing Address - Country:US
Mailing Address - Phone:703-980-5630
Mailing Address - Fax:
Practice Address - Street 1:2 PROFESSIONAL DR STE 212
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3420
Practice Address - Country:US
Practice Address - Phone:703-980-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02829171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist