Provider Demographics
NPI:1245313311
Name:CHEN, STEPHEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
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 1:14401 SOMMERVILLE CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6836
Mailing Address - Country:US
Mailing Address - Phone:804-285-4115
Mailing Address - Fax:
Practice Address - Street 1:1630 WILKES RIDGE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7460
Practice Address - Country:US
Practice Address - Phone:804-285-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057890208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010089905Medicaid
VA010089905Medicaid
005204M98Medicare ID - Type Unspecified