Provider Demographics
NPI:1023103041
Name:CHAO, PHILIP W (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:W
Last Name:CHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31286 PONDVIEW DR
Mailing Address - Street 2:RED MILL MANOR
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3600
Mailing Address - Country:US
Mailing Address - Phone:302-827-4251
Mailing Address - Fax:302-827-4351
Practice Address - Street 1:17252 N VILLAGE MAIN BLVD STE 9
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6292
Practice Address - Country:US
Practice Address - Phone:302-827-4251
Practice Address - Fax:302-827-4351
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1000034572085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA98650Medicare UPIN
DE666024Medicare PIN
DEA98650Medicare UPIN