Provider Demographics
NPI:1891716510
Name:CHEN, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
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 1:1009 N 4TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4768
Mailing Address - Country:US
Mailing Address - Phone:903-212-4330
Mailing Address - Fax:903-212-4333
Practice Address - Street 1:1009 N 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4768
Practice Address - Country:US
Practice Address - Phone:903-212-4330
Practice Address - Fax:903-212-4333
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0222252080N0001X
TXM6080208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494011Medicaid
LAG65748Medicare UPIN
LA5A284F600Medicare ID - Type Unspecified