Provider Demographics
NPI:1790769321
Name:CHEN, ROSEMARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S CLAY ST
Mailing Address - Street 2:SUITE 130E
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-654-3376
Mailing Address - Fax:630-655-3872
Practice Address - Street 1:40 S CLAY ST
Practice Address - Street 2:SUITE 130E
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-654-3376
Practice Address - Fax:630-655-3872
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36067339207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D15601Medicare UPIN
IL732883Medicare ID - Type Unspecified