Provider Demographics
NPI:1790747517
Name:CHENN, ANJEN (MD)
Entity Type:Individual
Prefix:
First Name:ANJEN
Middle Name:
Last Name:CHENN
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 1:1904 TW ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:RESEARCH TRIANGLE PARK
Mailing Address - State:NC
Mailing Address - Zip Code:27709-0153
Mailing Address - Country:US
Mailing Address - Phone:312-804-1841
Mailing Address - Fax:
Practice Address - Street 1:303 E CHICAGO AVE
Practice Address - Street 2:WARD 3-200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4296
Practice Address - Country:US
Practice Address - Phone:312-926-4384
Practice Address - Fax:312-503-4520
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107427207ZP0105X
NC2015-01037207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74477Medicare UPIN