Provider Demographics
NPI:1780679043
Name:CHEN, TONG Y (MD)
Entity Type:Individual
Prefix:
First Name:TONG
Middle Name:Y
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 1:1718 E 4TH ST
Mailing Address - Street 2:3RD FLOOR, STE. 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3260
Mailing Address - Country:US
Mailing Address - Phone:704-377-9410
Mailing Address - Fax:704-377-0288
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:3RD FLOOR, STE. 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3260
Practice Address - Country:US
Practice Address - Phone:704-377-9410
Practice Address - Fax:704-377-0288
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22389207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922242Medicaid
NCC87521Medicare UPIN
NC205387BMedicare ID - Type Unspecified