Provider Demographics
NPI:1790019974
Name:CHEN, LUN (PA-C)
Entity type:Individual
Prefix:
First Name:LUN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 OSLER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7736
Mailing Address - Country:US
Mailing Address - Phone:410-337-8888
Mailing Address - Fax:410-823-4833
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-337-8888
Practice Address - Fax:410-823-4833
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004060363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0004060OtherBOARD OF PHYSICIANS LICENSE