Provider Demographics
NPI:1952394579
Name:CHEN, MAO HSIUNG (MD)
Entity Type:Individual
Prefix:
First Name:MAO HSIUNG
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 1:801 W GIRARD AVE
Mailing Address - Street 2:ATTN BUSINESS OFFICE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-4212
Mailing Address - Country:US
Mailing Address - Phone:215-787-2000
Mailing Address - Fax:
Practice Address - Street 1:1600 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1615
Practice Address - Country:US
Practice Address - Phone:215-787-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035718L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001047351Medicaid
PA30000086OtherKEYSTONE MERCY
PA0002542201OtherAMERICHOICE
PA0414821000OtherINDEPENDENCE BLUE CROSS
PA015686OtherHIGHMARK
PA50087256OtherRR MEDICARE
PA08415OtherHEALTH PARTNERS
PA015686OtherHIGHMARK
PA0414821000OtherINDEPENDENCE BLUE CROSS